IDENTIFYING SOCIODEMOGRAPHIC, CLINICAL, AND ECHOCARDIOGRAPHIC PROFILES RELATED TO LEFT VENTRICULAR THROMBI FORMATION IN A SAFETY NET HOSPITAL

Abstract

TOPIC: Cardiovascular Disease TYPE: Original Investigations PURPOSE: Left ventricular thrombus (LVT) formation is associated with significant morbidity and mortality owing to the risk of thromboembolism. LVT has been studied extensively in relation to myocardial infarction (MI); however, few studies have identified the clinical, sociodemographic, and echocardiographic risk factors associated with clot formation. We aimed to identify and compare sociodemographic, clinical, and echocardiographic risk factors associated with LVT formation in a safety net hospital. METHODS: A database of 30,468 transthoracic echocardiogram (TTE) reports were surveyed retrospectively for the word "clot," "thrombus," "thrombi," from 2012-2018. Indications for TTE included suspicion of LVT and comorbidities often associated with LVT including myocardial infarction (MI), cardiac arrhythmias (i.e. atrial fibrillation, atrial flutter), cerebrovascular accidents (i.e. stroke, transient ischemic attacks). Several sociodemographic, clinical, and echocardiographic criteria were compiled based on availability and analyzed via t-tests for normal distributions, Mann-Whitney u test for non-normal distributions, and chi-squared tests for categorical variables comparing those with and without thrombi. Multivariate analysis was then used to identify independent risk factors. RESULTS: We identified 224 patients that were being investigated for LVT, of which 5 cases were excluded due to workup of right ventricular thrombus. Out of 219 patients, 72 patients had LVT while the other 147 did not have LVT, and were used as our control group. Patients with LVT were predominantly male (88% vs. 64%, p<0.001), undomiciled (15% vs. 5%, P=0.006), had a history of MI (44% vs. 16%, p<0.001), or a history of methamphetamine use (17% vs. 9%, p=0.087). A majority of patients with non-ischemic cardiomyopathy (NICM) did not have LVT formation (49% vs. 59%, p<0.001) whereas individuals with ischemic cardiomyopathy (ICM) tended to have higher rates of LVT formation (47% vs. 22%, p=0.002). LVT was noted primarily in patients with left ventricular ejection fraction (LVEF) < 40% (89% vs. 34% p<0.001) and regional wall motion abnormalities (32% vs. 14%, p<0.001) among other echocardiographic findings, patients with LVT had differences in mean end diastolic diameter (p=0.001), mean stroke volume (p=0.001), and mean mitral valve E/A ratio (p<0.001). Using multivariate analysis, male gender and moderate or severe impairment of LVEF were independently associated with LVT. CONCLUSIONS: Male sex, moderate and severe left ventricular systolic dysfunction, regardless of etiology are independently associated with LVT in a cohort of patients seen at a safety net hospital. The current study adds to the data available on potential risk factors that may portend LVT formation. CLINICAL IMPLICATIONS: Identification of clinical, echocardiographic and sociodemographic risk factors of left ventricular thrombus and patients at risk for screening DISCLOSURES: No relevant relationships by Rahul Ahuja, source=Web Response No relevant relationships by Shahad Al Chalaby, source=Web Response No relevant relationships by Sophie Barbant, source=Web Response No relevant relationships by Ghita Bouzarif, source=Web Response No relevant relationships by Steve Kong, source=Web Response No relevant relationships by Saba Lahsaei, source=Web Response No relevant relationships by Katherine leger, source=Web Response No relevant relationships by Kala Mehta, source=Web Response No relevant relationships by Marina Trilesskaya, source=Web Response