Impact of the morphology of the left ventricular thrombus on the clinical outcomes

The impact of thrombus morphology on the outcome of patients with left ventricular (LV) thrombus is uncertain. Our objectives were to evaluate the association between thrombus morphology and clinical outcomes and to explore whether anticoagulation duration differed according to LV thrombus morphology. We enrolled patients prospectively from 2020 to 2022 and retrospectively from 2010 to 2020 at the National Cardiovascular Center of China. Patients with a history of LV thrombus < 3 months were included. Inverse probability of treatment weighting (IPTW) Cox modeling was used to estimate associations between thrombus morphology and outcomes for the endpoints of thrombus resolution, the composite endpoint of major adverse cardiovascular events (MACE), and rehospitalization for cardiovascular events. Propensity score matching (PSM) and multivariable Cox regression models were adopted in additional sensitivity analyses. We included 623 patients, the majority of whom (84.9%) had mural thrombus. Congestive heart failure was diagnosed in 477 (76.6%) of the patients. Patients with protuberant thrombus received longer-duration anticoagulation (145 days versus 87 days, P < 0.001) and were more frequently treated with direct oral anticoagulants. In a median follow-up of 402 days, protuberant thrombus was associated with a higher probability of LV thrombus resolution in unadjusted and propensity-based analyses; however, this association was not confirmed in the multivariable Cox regression model (HR 1.08, 95%CI 0.81–1.43, P = 0.605). No significant differences in MACE were observed; however, the study was underpowered for clinical endpoints because of the low number of events. Protuberant LV thrombus may be associated with thrombus resolution in certain analytical settings; however, this association was not consistent across statistical models. In addition, the independent contribution of thrombus morphology could not be fully distinguished from treatment-related factors, including differences in anticoagulation duration and type. No significant differences in clinical outcomes were observed, although the study was underpowered for these endpoints. Therefore, the findings should be considered exploratory and interpreted with caution. Trial registration : This study was a combined cohort from two studies (ClinicalTrials.gov: NCT04970381, NCT 05006677).