Yang Jing, Deng Mingjun, Li Jing
Department of Cardiology, Gansu Provincial Hospital, Lanzhou 730000, China.
Department of Cardiology, Qingyang First People's Hospital, QingYang 745000, China.
Radiol Case Rep. 2024 Sep 10;19(12):5708-5712. doi: 10.1016/j.radcr.2024.08.086. eCollection 2024 Dec.
Severe left ventricular dysfunction and ventricular wall motion abnormalities predispose individuals to thrombosis and thromboembolism. Thromboembolism is one of the main causes of increased mortality in patients with heart failure and reduced ejection fraction (HFrEF). However, regarding thromboembolism due to HFrEF in sinus rhythm, most cases to date have reported ischemic strokes, and repeated embolization of peripheral arteries has been reported not uncommon. Herein, we report the case of a 48-year-old man with a definite diagnosis of sinus rhythm HFrEF and recurrent peripheral arterial embolization within a short period. The condition is caused by severe left ventricular systolic dysfunction and abnormal left ventricular wall motion, resulting in blood stasis and abnormal blood composition, with or without left ventricular thrombosis, and can lead to thromboembolism. Current guidelines state that patients with heart failure and clear indication(s) for anticoagulation (e.g., atrial fibrillation, heart valve replacement) should be administered appropriate anticoagulation therapy. However, controversy persists regarding whether patients with HFrEF in sinus rhythm can benefit from anticoagulation therapy. This case highlights the utility and necessity of anticoagulation for the prevention of intracardiac thrombosis and the treatment of peripheral arterial embolism in patients with HFrEF in sinus rhythm.
严重的左心室功能障碍和心室壁运动异常使个体易发生血栓形成和血栓栓塞。血栓栓塞是心力衰竭且射血分数降低（HFrEF）患者死亡率增加的主要原因之一。然而，关于窦性心律的HFrEF所致的血栓栓塞，迄今为止大多数病例报告的是缺血性卒中，且反复的外周动脉栓塞也并不少见。在此，我们报告一例48岁男性，明确诊断为窦性心律HFrEF且在短时间内发生反复外周动脉栓塞。该病症由严重的左心室收缩功能障碍和左心室壁运动异常引起，导致血液淤滞和血液成分异常，伴或不伴有左心室血栓形成，并可导致血栓栓塞。当前指南指出，有心力衰竭且有明确抗凝指征（如心房颤动、心脏瓣膜置换）的患者应接受适当的抗凝治疗。然而，窦性心律的HFrEF患者是否能从抗凝治疗中获益仍存在争议。该病例突出了抗凝治疗在预防窦性心律的HFrEF患者心内血栓形成及治疗外周动脉栓塞方面的作用和必要性。
