{"title":"停止抗凝治疗后左心室血栓复发","authors":"Kamran Namjouyan , Aastha Mittal , Seth Krueger , Devon Chosky , Enrique Soltero , Idorenyin Udoeyo","doi":"10.1016/j.ijcha.2024.101480","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Evidence regarding the duration of anticoagulation (AC) therapy for left ventricular thrombus (LVT) is lacking. This study aims to evaluate the rate and risk factors for LVT recurrence in patients with Anterior ST-Segment elevation Myocardial Infarction (STEMI) complicated by LVT.</p></div><div><h3>Methods</h3><p>This was a retrospective analysis of patients with Anterior STEMI complicated by LVT and reduced ejection fraction (<35 %) from 2010 to 2020. Patients with atrial fibrillation and hypercoagulable state were excluded. Recurrence of LVT was defined as a new LVT on transthoracic echocardiography (TTE) after interval resolution and AC discontinuation. Demographics, comorbidities, guideline directed medical therapy, TTE, and angiographic characteristics were assessed and compared in patients with and without LVT recurrence.</p></div><div><h3>Results</h3><p>87 patients met the inclusion criteria. Nine (10.3 %) had LVT recurrence of which three (33.3 %) had cardioembolic events. More patients with recurrence had ventricular aneurysm/scarring (33 % vs 10.3 %) and multi-vessel disease (22.2 % vs 9 %).</p></div><div><h3>Conclusion</h3><p>This study reveals that a portion of patients with Anterior STEMI complicated by LVT are at a higher risk of recurrence after initial resolution and AC discontinuation. Larger prospective trials are needed to re-address the appropriate duration of anticoagulation.</p></div>","PeriodicalId":38026,"journal":{"name":"IJC Heart and Vasculature","volume":"54 ","pages":"Article 101480"},"PeriodicalIF":2.5000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352906724001465/pdfft?md5=adf79e10ff1f3bffd0527c4cd87e5e3b&pid=1-s2.0-S2352906724001465-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Left ventricular thrombus recurrence after anticoagulation discontinuation\",\"authors\":\"Kamran Namjouyan , Aastha Mittal , Seth Krueger , Devon Chosky , Enrique Soltero , Idorenyin Udoeyo\",\"doi\":\"10.1016/j.ijcha.2024.101480\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Evidence regarding the duration of anticoagulation (AC) therapy for left ventricular thrombus (LVT) is lacking. 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More patients with recurrence had ventricular aneurysm/scarring (33 % vs 10.3 %) and multi-vessel disease (22.2 % vs 9 %).</p></div><div><h3>Conclusion</h3><p>This study reveals that a portion of patients with Anterior STEMI complicated by LVT are at a higher risk of recurrence after initial resolution and AC discontinuation. 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引用次数: 0
摘要
背景有关左心室血栓（LVT）抗凝治疗（AC）持续时间的证据尚缺。本研究旨在评估前ST段抬高型心肌梗死（STEMI）并发左心室血栓患者的左心室血栓复发率和风险因素。方法这是对2010年至2020年间前STEMI并发左心室血栓和射血分数降低（<35 %）患者的回顾性分析。排除了心房颤动和高凝状态患者。经胸超声心动图（TTE）显示，间歇期缓解和停用 AC 后出现新的 LVT，即为 LVT 复发。对 LVT 复发和未复发患者的人口统计学、合并症、指南指导的药物治疗、TTE 和血管造影特征进行了评估和比较。9例（10.3%）左心室支架复发，其中3例（33.3%）发生了心肌栓塞事件。更多复发患者患有心室动脉瘤/瘢痕（33 % vs 10.3 %）和多血管疾病（22.2 % vs 9 %）。需要进行更大规模的前瞻性试验，以重新确定适当的抗凝时间。
Left ventricular thrombus recurrence after anticoagulation discontinuation
Background
Evidence regarding the duration of anticoagulation (AC) therapy for left ventricular thrombus (LVT) is lacking. This study aims to evaluate the rate and risk factors for LVT recurrence in patients with Anterior ST-Segment elevation Myocardial Infarction (STEMI) complicated by LVT.
Methods
This was a retrospective analysis of patients with Anterior STEMI complicated by LVT and reduced ejection fraction (<35 %) from 2010 to 2020. Patients with atrial fibrillation and hypercoagulable state were excluded. Recurrence of LVT was defined as a new LVT on transthoracic echocardiography (TTE) after interval resolution and AC discontinuation. Demographics, comorbidities, guideline directed medical therapy, TTE, and angiographic characteristics were assessed and compared in patients with and without LVT recurrence.
Results
87 patients met the inclusion criteria. Nine (10.3 %) had LVT recurrence of which three (33.3 %) had cardioembolic events. More patients with recurrence had ventricular aneurysm/scarring (33 % vs 10.3 %) and multi-vessel disease (22.2 % vs 9 %).
Conclusion
This study reveals that a portion of patients with Anterior STEMI complicated by LVT are at a higher risk of recurrence after initial resolution and AC discontinuation. Larger prospective trials are needed to re-address the appropriate duration of anticoagulation.
期刊介绍：
IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.
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