Clinical predictors and prognostic impact of left ventricular thrombus recurrence

Background There is limited contemporary data available on the subject of left ventricular thrombus (LVT) recurrence. This study aimed to evaluate the incidence, outcomes and predictors of patients with LVT recurrence after resolution. Methods This was a retrospective cohort study involving 346 patients with resolved LVT at baseline, derived from an echocardiography database at a tertiary medical centre, from March 2011 to January 2021. Patients were stratified based on the presence of LVT recurrence during follow-up, with subgroup analysis performed for patients who developed LVT post-acute myocardial infarction (AMI) over a median follow-up duration of 4.4 years. Results The incidence of LVT recurrence was 11.8% (n=41/346) among all resolved LVT (mean age of 59.9±11.6 years, 86.4% male), and 12.0% (n=23/192) in patients with post-AMI resolved LVT. On multivariable regression analyses accounting for competing risks (all-cause mortality), active or previous malignancy was associated with LVT recurrence in both all (adjusted subdistribution HR (aSHR) 5.59, 95% CI 2.02 to 15.5, p<0.001) and patients with post-AMI (aSHR 13.9, 95% CI 4.05 to 47.7, p<0.001) resolved LVT. Initial LVT characteristics such as size (per cm) (aSHR 1.42, 95% CI 1.02 to 1.96, p=0.036) and protrusion (aSHR 5.46, 95% CI 1.38 to 21.6, p=0.016) were associated with recurrence in all and patients with post-AMI, respectively. On multivariable Cox regression analyses, LVT recurrence was associated with increased composite outcomes (comprising AMI, acute ischaemic stroke, acute decompensated heart failure, all-cause mortality) in all patients with resolved LVT (adjusted HR (aHR) 3.04, 95% CI 1.70 to 5.44, p<0.001), and in the post-AMI subgroup (aHR 2.77, 95% CI 1.21 to 6.32, p=0.016). Conclusions Active or previous malignancy, and initial LVT imaging characteristics were associated with recurrent LVT. LVT recurrence was a marker of poor prognosis in terms of adverse composite outcomes in patients with resolved LVT.