Costantino Jacopo, Maria Ajmone Francesco, Maggio Enrico, Ballatore Federico, Manguso Giulia, Ciaramella Piera, Galea Nicola, Alfarano Maria, Severino Paolo, Lavalle Carlo, Vizza Carmine Dario, Chimenti Cristina
Dipartimento di Scienze Cliniche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, Roma.
Dipartimento di Scienze Radiologiche, Oncologiche e Anatomo-Patologiche, Sapienza Università di Roma, Roma.
G Ital Cardiol (Rome). 2023 Nov;24(11):866-871. doi: 10.1714/4129.41229.
Left ventricular non compaction (LVNC) comprises a heterogeneous group of diseases that can cause heart failure, arrhythmias, and thromboembolic events. In particular, the prevalence of thromboembolism in patients with LVNC is relevant compared to the general population. Atrial fibrillation and left ventricular thrombosis are strong predictors and require anticoagulant treatment in primary or secondary prevention, with a significant reduction in the risk of events. Long-term oral anticoagulation can be considered in patients with LVNC associated with left ventricular systolic dysfunction and sinus rhythm. On the contrary, it is not entirely clear whether the presence of deep intertrabecular recesses that cause blood flow stagnation can itself represent a thrombogenic substrate even in the absence of ventricular dysfunction and in sinus rhythm, thus indicating the use of anticoagulation.This article addresses the open question of the indication for anticoagulant therapy in LVNC, through a review of the current evidence on thromboembolic risk stratification and the initiation of anticoagulant therapy and by proposing a flow-chart as a guide to decision-making according to the clinical picture of the patient.
左心室心肌致密化不全（LVNC）是一组异质性疾病，可导致心力衰竭、心律失常和血栓栓塞事件。特别是，与普通人群相比，LVNC患者的血栓栓塞患病率较高。心房颤动和左心室血栓形成是强有力的预测因素，在一级或二级预防中需要进行抗凝治疗，可显著降低事件风险。对于伴有左心室收缩功能障碍和窦性心律的LVNC患者，可考虑长期口服抗凝治疗。相反，即使在没有心室功能障碍和窦性心律的情况下，导致血流停滞的深部小梁间隐窝的存在本身是否可代表血栓形成的基质，从而提示使用抗凝治疗，目前尚不完全清楚。本文通过回顾目前关于血栓栓塞风险分层和抗凝治疗启动的证据，并提出一个流程图作为根据患者临床表现进行决策的指南，探讨了LVNC患者抗凝治疗指征这一开放性问题。
