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Master Thesis

Le thrombus intra-ventriculaire gauche dans l'insuffisance cardiaque

Abstract : Background: heart failure with reduced ejection fraction (EF<40%) is a growing source of left ventricular thrombus (LVT) but LVT complicating ischemic (ICM) or non-ischemic dilated cardiomyopathy (DCM) are barely described. Purpose: through a retrospective monocentric study, we aimed at describing DCM and ICM with LVT, their prognosis and complications. Methods: we studied all DCM and ICM patients with LVT in our institution from 2005 to 2018. Stenosing or prosthetic valves, heart transplant, LVAD, congenital diseases, acute myocardial infarction (AMI) were excluded. Our primary endpoint was a composite of all-cause mortality (ACM), symptomatic embolic event (stroke, AMI, symptomatic peripheral embolic events) during the 1st year. Secondary endpoints were suspected/transient embolic events, major bleeding and LV reverse remodelling (LVRR) described as an increase of LVEF >10% or a decrease in LV volume/diameter >10%. We compared our DCM patients to DCM without LVT for case-control analysis. Results: 38 DCM and 67 ICM were included. Mean age was 56±13, 85% were males. DCM had higher NYHA, BNP level, lower LVEF. The primary endpoint occurred in 20% without difference between groups. ACM the 1st year was 5.7% (6 patients) and cardio-vascular mortality 4.8% (5 pts). Symptomatic embolic events occurred in 15% without difference between groups. We noted suspected/transient embolic events in 13% of cases: 29% of DCM (11 pts), 4.5% of ICM (3 pts, p<0.01). 5 patients had a LVT surgery, 1 DCM didn't receive anticoagulant treatment because of a major bleeding, 2 ICM because of a high bleeding risk. Major bleedings weren't different (4.8%). LVRR was observed in 65% of cases after 1 year and more frequently in DCM (86%) than ICM (54%, p=0.02). DCM patients with a LVT had a significantly higher BNP level compared to DCM without LVT. Conclusion: LVT is associated with a significant rate of embolic events but doe! sn't seem to impact mortality and doesn't preclude reverse remodelling.
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Anne-Iris Lemaitre. Le thrombus intra-ventriculaire gauche dans l'insuffisance cardiaque. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02443466⟩

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