Clinical and Echocardiographic Factors Associated With Left Ventricular Thrombus Recurrence

BACKGROUND: Left ventricular (LV) thrombus (LVT) recurrence risk influences decision-making regarding oral anticoagulation (OAC) duration. OBJECTIVES: The aim of the study was to evaluate risk of LVT recurrence and factors associated with recurrence. METHODS: This was a multicenter, retrospective cohort of patients with resolved LVT, diagnosed by echocardiography. Clinical and echocardiographic characteristics at LVT diagnosis and resolution were evaluated for association with recurrence. Multivariable Cox proportional hazards regression was used to identify determinants of LVT recurrence. RESULTS: Among 252 patients (mean age 64.5 years, 78.6% male), LVT recurred in 36 (14.3%). Although LV systolic function at the time of presentation was similar between those with and without recurrence, patients who developed recurrent LVT had lower LV ejection fraction (LVEF) (34.0% vs 40.0%; P = 0.04) and more frequently had LV apical aneurysm (25.0% vs 6.5%; P = 0.001) at LVT resolution. Continuing OAC after LVT resolution was associated with less recurrence (54.7% vs 25.0%; P = 0.005). In multivariable analysis, LV apical aneurysm (HR: 3.12; 95% CI: 1.43 to 6.84) and previous ischemic stroke (HR: 2.75; 95% CI: 1.22-6.17) were associated with higher rates of recurrence, whereas higher LVEF (HR: 0.96 per 1% increase; 95% CI: 0.95-0.99) and OAC continuation (HR: 0.27; 95% CI: 0.13-0.58) were associated with decreased recurrence. CONCLUSIONS: In this population, LVT recurred in 14% of patients and was associated with LV apical aneurysm and prior stroke, whereas lower rates of recurrence were associated with higher LVEF and continuation of OAC. Echocardiographic characteristics at the time of LVT resolution were associated with LVT recurrence.