Sharma N D, McCullough P A, Philbin E F, Weaver W D
Henry Ford Heart and Vascular Institute, Henry Ford Health System, Detroit, MI 48202, USA.
Chest. 2000 Feb;117(2):314-20. doi: 10.1378/chest.117.2.314.
To determine the frequency of left ventricular (LV) thrombi by echocardiography and to define the predictors of LV thrombus and subsequent thromboembolism.
Retrospective case-control design.
Single tertiary care center.
Twenty-eight patients with LV thrombus in a consecutive series of 144 patients with severe LV dysfunction and follow-up period for a mean of 27.6 months.
Thirty-five clinical and echocardiographic variables were evaluated. The mean age of patients with (n = 28) vs patients without (n = 116) LV thrombus was 50.3 +/- 11.0 years vs 54.2 +/- 11.1 years (p = 0.09), with 22 patients (78.6%) and 78 patients (67.2%) being male (p = 0.24), respectively. The mean ejection fraction (EF) for those with vs those without LV thrombus was 17.5 +/- 5.5 vs 20.0 +/- 6.9 (p = 0. 08), with 16 patients (57.1%) and 42 patients (36.2%) having an EF < 20% (p = 0.04), respectively. The groups were similar with respect to other baseline characteristics, comorbid illnesses, and drug therapies other than anticoagulants. All 28 patients with LV thrombus (100%) and 54 of those without LV thrombus (46.6%) were treated with warfarin. Ischemic etiology of the cardiomyopathy (odds ratio, 4.78; 95% confidence interval, 1.51 to 15.11; p = 0.008) and increased LV internal diastolic dimension (LVIDD; odds ratio, 1.10; 95% confidence interval, 1.03 to 1.18; p = 0.004) were found to be independent predictors of thrombus formation. Peripheral embolism occurred in 5 patients (17.9%) vs 13 patients (11.2%) of those with and without LV thrombi, respectively (p = 0.35). Ischemic etiology of the cardiomyopathy (odds ratio, 3.79; 95% confidence interval, 1. 13 to 12.64; p = 0.03) and EF (odds ratio, 0.91; 95% confidence interval, 0.82 to 1.00; p = 0.04) were found to be independent predictors of systemic embolization. The patients with an embolic event suffered a significantly higher mortality (7 of 18 patients; 38.9%) during the follow-up period when compared to those without an embolic event (13 of 126 patients; 10.3%; p < 0.0001).
We conclude that ischemic cardiomyopathy and dilated LV chamber sizes (LVIDD > 60 mm) are independently associated with LV thrombi. A peripheral embolic event is related to poor long-term survival in this patient group.
通过超声心动图确定左心室（LV）血栓的发生率，并明确LV血栓及随后血栓栓塞的预测因素。
回顾性病例对照研究。
单一的三级医疗中心。
在连续的144例严重LV功能障碍患者中，有28例患者存在LV血栓，平均随访期为27.6个月。
评估了35项临床和超声心动图变量。有LV血栓的患者（n = 28）与无LV血栓的患者（n = 116）的平均年龄分别为50.3±11.0岁和54.2±11.1岁（p = 0.09），男性患者分别为22例（78.6%）和78例（67.2%）（p = 0.24）。有LV血栓与无LV血栓患者的平均射血分数（EF）分别为17.5±5.5和20.0±6.9（p = 0.08），EF<20%的患者分别为16例（57.1%）和42例（36.2%）（p = 0.04）。除抗凝剂外，两组在其他基线特征、合并疾病和药物治疗方面相似。所有28例有LV血栓的患者（100%）和54例无LV血栓的患者（46.6%）接受了华法林治疗。发现心肌病的缺血性病因（比值比，4.78；95%置信区间，1.51至15.11；p = 0.008）和左心室内径舒张末期增加（LVIDD；比值比，1.10；95%置信区间，1.03至1.18；p = 0.004）是血栓形成的独立预测因素。有LV血栓的患者中有5例（17.9%）发生外周栓塞，无LV血栓的患者中有13例（11.2%）发生外周栓塞（p = 0.35）。发现心肌病的缺血性病因（比值比，3.79；95%置信区间，1.13至12.64；p = 0.03）和EF（比值比，0.91；95%置信区间，0.82至1.00；p = 0.04）是全身栓塞的独立预测因素。与无栓塞事件的患者相比，发生栓塞事件的患者在随访期间的死亡率显著更高（18例患者中有7例；38.9%）（126例患者中有13例；10.3%；p<0.0001）。
我们得出结论，缺血性心肌病和扩大的左心室腔大小（LVIDD>60mm）与LV血栓独立相关。外周栓塞事件与该患者群体的长期生存率低有关。
