Echocardiographic measures associated with the presence of left ventricular thrombus in patients with chemotherapy-related cardiac dysfunction.

Abstract

Previous studies have not evaluated the prevalence and specific risk factors for the development of left ventricular (LV) thrombus in patients with severely reduced left ventricular dysfunction due to chemotherapy-related cardiomyopathy. We sought to evaluate the prevalence and potential markers of LV thrombus in this patient population. From January 2009 to December 2013, patients with chemotherapy-related severe LV dysfunction (LV ejection fraction [LVEF]≤30%) identified from MD Anderson Cancer Center database were reviewed. Patient characteristics and echocardiographic parameters were analyzed to determine potential risk factors for LV thrombus. A total of 121 patients met inclusion criteria (age 54.8±15.2years; female 63.6%; LVEF 26.3±4%). LV thrombus was present in 9 patients (7.4%). Patients with LV thrombus have significantly lower LVEF compared to those without (18.7±3.8% vs 26.9±3.4%, P<.0001). Prevalence of LV thrombus increased as LVEF decreased and was the highest in patients with LVEF<20%. By univariate analysis, decreased LVEF, particularly LVEF<20% (OR 36.30, 95% CI 7.35-179.25, P<.0001) and restrictive LV filling pattern (OR 18.13, 95% CI 4.17-78.89, P=.0001) were associated with presence of LV thrombus. In patients with severely reduced LV systolic function due to chemotherapy-induced cardiomyopathy, LV thrombus was found in 7.4% of subjects. Severely decreased LVEF (<20%) and restrictive LV filling pattern were associated with the presence of LV thrombus.