Araştırma Makalesi
Yıl 2022,
Cilt: 7 Sayı: 4, 586 - 592, 10.12.2022
Öz
Amaç: Sol ventrikül apikal trombüsü (LVAT), akut miyokard enfarktüsü sonrası hastalarda artmış morbidite ve mortalite ile ilişkilidir. Bu çalışmada sol ventrikül apikal trombozu ile CHA2DS2-VASc skorlama sistemi arasındaki ilişkiyi değerlendirmek amaçlandı.
Materyal ve Metot: Bu çalışmaya Ocak 2010 ile Ocak 2020 arasında kliniğimizde takip edilen 456 (LVAT'li 146, kontrol grubu ile benzer demografik özelliklere sahip ventriküler trombozu olmayan 300) hasta dahil edildi.
Bulgular: Tüm çalışma popülasyonunda tanı sırasında ortalama CHA2DS2-VASc skoru 3,05±1,34 olarak hesaplandı ve CHA2DS2-VASc skoru LVAT'de istatistiksel olarak daha yüksekti (p= 0,029). LVAT grubunda CHA2DS2-VASc skoru 2'nin üzerinde olan hasta sayısı %79 iken kontrol grubunda %55 idi (p <0,001). Ejeksiyon fraksiyonu gruplar arasında benzerdi, ancak LVAT grubundaki hastalarda sol ventrikül diyastolik/sistolik çapları ve sol atriyum çapı daha büyüktü (sırasıyla; p=0,793, p=0,001). CHA2DS2-VASc skoru, koroner arter hastalığı varlığı LVAT için bağımsız risk faktörleriydi (sırasıyla; β= 0,385, p= 0,001, β= 0,265, p= 0,045).
Sonuç: LVAT'li hastalarda CHA2DS2-VASc skoru daha yüksek olma eğilimindeydi ve daha yüksek bir CHA2DS2-VASc skoru, LVAT insidansının bağımsız bir öngördürücüsü olarak bulundu. İdiyopatik sistemik emboli öyküsü olan ve yüksek CHA2DS2-VASc skoru (≥2) olan kalp yetmezliği hastalarında sol ventrikül trombüsü akılda tutulmalıdır.
Anahtar Kelimeler
Sol ventriküler apikal trombüs CHA2DS2-VASc skoru kalp yetmezliği
Destekleyen Kurum
YOK
Proje Numarası
yok
Kaynakça
- Choi UL, Park JH, Sun BJ, Oh JK, Seong SW, Lee JH. Impaired left ventricular diastolic function is related to the formation of left ventricular apical thrombus in patients with acute anterior myocardial infarction. Heart Vessels. 2018;33(5):447-452. doi:10.1007/s00380-017-1079-z
- Satish M, Vukka N, Apala D, Mahfood Haddad T, Gupta J. Left ventricular thrombus after acute decompensated heart failure in the setting of ıschemic cardiomyopathy. Cureus. 2019;11(4):e4537. doi:10.7759/cureus.4537
- Lemaître AI, Picard F, Maurin V, Faure M, Dos Santos P, Girerd N. Clinical profile and midterm prognosis of left ventricular thrombus in heart failure. ESC Heart Fail. 2021. doi:10.1002/ehf2.13211
- Lee JM, Park JJ, Jung HW, et al. Left ventricular thrombus and subsequent thromboembolism, comparison of anticoagulation, surgical removal, and antiplatelet agents. J Atheroscler Thromb. 2013;20(1):73-93. doi:10.5551/jat.13540
- McCarthy CP, Vaduganathan M, McCarthy KJ, Januzzi JL Jr, Bhatt DL, McEvoy JW. Left ventricular thrombus after acute myocardial ınfarction: screening, prevention, and treatment. JAMA Cardiol. 2018;3(7):642-649. doi:10.1001/jamacardio.2018.1086
- Aljaber NN, Mattash ZA, Alshoabi SA, Alhazmi FH. The prevalence of left ventricular thrombus among patients with low ejection fraction by trans-thoracic echocardiography. Pak J Med Sci. 2020;36(4):673-677. doi:10.12669/pjms.36.4.1972
- Kirchhof P, Benussi S, Kotecha D, ve ark. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016;18(11):1609-1678.
- Akboğa MK, Yılmaz S, Yalçın R. Prognostic value of CHA2DS2-VASc score in predicting high SYNTAX score and in-hospital mortality for non-ST elevation myocardial infarction in patients without atrial fibrillation. Anatol J Cardiol. 2021;25(11):789-795. doi:10.5152/AnatolJCardiol.2021.03982
- Temizer O, Açar B, Yayla Ç, ve ark. The association between CHA2DS2-VASc score and mortality in patients with heart failure with reduced ejection fraction. Acta Cardiol Sin. 2017;33(4):429-435.
- Onuk T, Karataş MB, İpek G, ve ark. Higher CHA2DS2-VASc score is associated with increased mortality in acute pulmonary embolism. Clin Appl Thromb Hemost. 2017;23(6):631-637.
- Ünal S, Açar B, Yayla Ç, ve ark. Importance and usage of the CHA2DS2-VASc score in predicting acute stent thrombosis. Coron Artery Dis. 2016;27(6):478-82. doi:10.1097/MCA.0000000000000388
- Camm AJ, Kirchhof P, Lip GY, ve ark. Guidelines for the management of atrial fibrillation: The task force for the management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) endorsed by the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2010;31(19):2369-429. doi:10.1093/eurheartj/ehq278
- Yu I, Song TJ, Kim BJ, et al. CHADS2, CHA2DS2-VASc, ATRIA, and Essen stroke risk scores in stroke with atrial fibrillation: A nationwide multicenter registry study. Medicine (Baltimore). 2021;100(3):e24000. doi:10.1097/MD.0000000000024000
- Mir JU, Raheel Jahangir J, Asfandyar Q, Sher Ali K, Syed Abbas A, Muhammad Zeeshan H. Left ventricular thrombus in patients with acute anterior wall myocardial infarction. J Ayub Med Coll Abbottabad. 2014;26(4):491-495.
- Gellen B, Biere L, Logeart D, ve ark. Timing of cardiac magnetic resonance imaging impacts on the detection rate of left ventricular thrombus after myocardial ınfarction. JACC Cardiovasc Imaging. 2017;10(11):1404-1405. doi:10.1016/j.jcmg.2016.12.006
- Bakalli A, Georgievska-Ismail L, Koçinaj D, Musliu N, Krasniqi A, Pllana E. Prevalence of left chamber cardiac thrombi in patients with dilated left ventricle at sinus rhythm: the role of transesophageal echocardiography. J Clin Ultrasound. 2013;41(1):38-45. doi:10.1002/jcu.21953
- Hopper I, Skiba M, Krum H. Updated meta-analysis on antithrombotic therapy in patients with heart failure and sinus rhythm. Eur J Heart Fail. 2013;15(1):69-78. doi:10.1093/eurjhf/hfs171
- Velangi PS, Choo C, Chen KA, ve ark. Long-term embolic outcomes after detection of left ventricular thrombus by late gadolinium enhancement cardiovascular magnetic resonance imaging: A matched cohort study. Circ Cardiovasc Imaging. 2019;12(11):e009723. doi:10.1161/CIRCIMAGING.119.009723
- You J, Wang X, Wu J, ve ark. Predictors and prognosis of left ventricular thrombus in post-myocardial infarction patients with left ventricular dysfunction after percutaneous coronary intervention. J Thorac Dis. 2018;10(8):4912-4922. doi:10.21037/jtd.2018.07.69
- Zannad F, Stough WG, Regnault V, ve ark. Is thrombosis a contributor to heart failure pathophysiology? Possible mechanisms, therapeutic opportunities, and clinical investigation challenges. Int J Cardiol. 2013;167(5):1772-82. doi:10.1016/j.ijcard.2012.12.018
- Jiwani S, Mustafa U, Desai S, Dominic P. Survival benefit of aspirin in patients with congestive heart failure: A meta-analysis. J Clin Med Res. 2021;13(1):38-47. doi:10.14740/jocmr4389
- Iguchi M, Kato T, Yaku H, ve ark. Ischemic stroke in acute decompensated heart failure: From the KCHF registry. J Am Heart Assoc. 2021;10(21):e022525. doi:10.1161/JAHA.121.022525
- Zhang S, Wang T, Wang H, ve ark. Effects of individualized administration of folic acid on prothrombotic state and vascular endothelial function with H-type hypertension: A double-blinded, randomized clinical cohort study. Medicine (Baltimore). 2022;101(3):e28628. doi:10.1097/MD.0000000000028628
- Cullivan S, Murphy CA, Weiss L, ve ark. Platelets, extracellular vesicles and coagulation in pulmonary arterial hypertension. Pulm Circ. 2021 Jun 4;11(3):20458940211021036. doi: 10.1177/20458940211021036
- Kakar P, Lip GY. Hypertension: endothelial dysfunction, the prothrombotic state and antithrombotic therapy. Expert Rev Cardiovasc Ther. 2007;5(3):441-50. doi:10.1586/14779072.5.3.441
- Amin H, Mohsin S, Aslam M, ve ark. Coagulation factors and antithrombin levels in young and elderly subjects in Pakistani population. Blood Coagul Fibrinolysis. 2012;23(8):745-50. doi:10.1097/MBC.0b013e328358e913
Relationship between CHA2DS2-VASc Score and Left Ventricular Apical Thrombosis in Patients with Heart Failure
Öz
Objective: Left ventricular apical thrombus (LVAT) is associated with increased morbidity and mortality in patients after acute myocardial infarction. In this study, it was aimed to evaluate the relationship between the left ventricle apical thrombosis and the CHA2DS2-VASc scoring system.
Materials and Methods: A total of 456 patients (146 with LVAT, 300 without ventricular thrombosis with demographic characteristics similar to the control group) followed in our clinic between January 2010 and January 2020 were included in this study.
Results: The mean CHA2DS2-VASc score was calculated as 3.05±1.34 in the whole study population during diagnosis and CHA2DS2-VASc score was higher statistical significance in the LVAT (p= 0.029). While the number of patients with CHA2DS2-VASc score above 2 in the LVAT group was 79%, it was 55% in the control group (p <0.001). The ejection fraction was similar between the groups (p= 0.793) but left ventricular diastolic/systolic diameters and the left atrium diameter were larger in patients with the LVAT group (p= 0.793, p= 0.001, respectively). The CHA2DS2-VASc score, and presence of coronary artery disease were independent risk factors for LVAT (β= 0.385, p= 0.001, β= 0.265, p= 0.045, respectively).
Conclusion: According to the data in our study, the CHA2DS2-VASc score tended to be higher in patients with LVAT and a higher CHA2DS2-VASc score was found to be an independent predictor of incidence of LVAT. Left ventricular thrombus should be kept in mind in heart failure patients with a history of idiopathic systemic embolism and high CHA2DS2-VASc score (≥2).
Anahtar Kelimeler
Left ventriküler apikal trombüs CHA2DS2-VASc score heart failure
Proje Numarası
yok
Kaynakça
- Choi UL, Park JH, Sun BJ, Oh JK, Seong SW, Lee JH. Impaired left ventricular diastolic function is related to the formation of left ventricular apical thrombus in patients with acute anterior myocardial infarction. Heart Vessels. 2018;33(5):447-452. doi:10.1007/s00380-017-1079-z
- Satish M, Vukka N, Apala D, Mahfood Haddad T, Gupta J. Left ventricular thrombus after acute decompensated heart failure in the setting of ıschemic cardiomyopathy. Cureus. 2019;11(4):e4537. doi:10.7759/cureus.4537
- Lemaître AI, Picard F, Maurin V, Faure M, Dos Santos P, Girerd N. Clinical profile and midterm prognosis of left ventricular thrombus in heart failure. ESC Heart Fail. 2021. doi:10.1002/ehf2.13211
- Lee JM, Park JJ, Jung HW, et al. Left ventricular thrombus and subsequent thromboembolism, comparison of anticoagulation, surgical removal, and antiplatelet agents. J Atheroscler Thromb. 2013;20(1):73-93. doi:10.5551/jat.13540
- McCarthy CP, Vaduganathan M, McCarthy KJ, Januzzi JL Jr, Bhatt DL, McEvoy JW. Left ventricular thrombus after acute myocardial ınfarction: screening, prevention, and treatment. JAMA Cardiol. 2018;3(7):642-649. doi:10.1001/jamacardio.2018.1086
- Aljaber NN, Mattash ZA, Alshoabi SA, Alhazmi FH. The prevalence of left ventricular thrombus among patients with low ejection fraction by trans-thoracic echocardiography. Pak J Med Sci. 2020;36(4):673-677. doi:10.12669/pjms.36.4.1972
- Kirchhof P, Benussi S, Kotecha D, ve ark. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016;18(11):1609-1678.
- Akboğa MK, Yılmaz S, Yalçın R. Prognostic value of CHA2DS2-VASc score in predicting high SYNTAX score and in-hospital mortality for non-ST elevation myocardial infarction in patients without atrial fibrillation. Anatol J Cardiol. 2021;25(11):789-795. doi:10.5152/AnatolJCardiol.2021.03982
- Temizer O, Açar B, Yayla Ç, ve ark. The association between CHA2DS2-VASc score and mortality in patients with heart failure with reduced ejection fraction. Acta Cardiol Sin. 2017;33(4):429-435.
- Onuk T, Karataş MB, İpek G, ve ark. Higher CHA2DS2-VASc score is associated with increased mortality in acute pulmonary embolism. Clin Appl Thromb Hemost. 2017;23(6):631-637.
- Ünal S, Açar B, Yayla Ç, ve ark. Importance and usage of the CHA2DS2-VASc score in predicting acute stent thrombosis. Coron Artery Dis. 2016;27(6):478-82. doi:10.1097/MCA.0000000000000388
- Camm AJ, Kirchhof P, Lip GY, ve ark. Guidelines for the management of atrial fibrillation: The task force for the management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) endorsed by the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2010;31(19):2369-429. doi:10.1093/eurheartj/ehq278
- Yu I, Song TJ, Kim BJ, et al. CHADS2, CHA2DS2-VASc, ATRIA, and Essen stroke risk scores in stroke with atrial fibrillation: A nationwide multicenter registry study. Medicine (Baltimore). 2021;100(3):e24000. doi:10.1097/MD.0000000000024000
- Mir JU, Raheel Jahangir J, Asfandyar Q, Sher Ali K, Syed Abbas A, Muhammad Zeeshan H. Left ventricular thrombus in patients with acute anterior wall myocardial infarction. J Ayub Med Coll Abbottabad. 2014;26(4):491-495.
- Gellen B, Biere L, Logeart D, ve ark. Timing of cardiac magnetic resonance imaging impacts on the detection rate of left ventricular thrombus after myocardial ınfarction. JACC Cardiovasc Imaging. 2017;10(11):1404-1405. doi:10.1016/j.jcmg.2016.12.006
- Bakalli A, Georgievska-Ismail L, Koçinaj D, Musliu N, Krasniqi A, Pllana E. Prevalence of left chamber cardiac thrombi in patients with dilated left ventricle at sinus rhythm: the role of transesophageal echocardiography. J Clin Ultrasound. 2013;41(1):38-45. doi:10.1002/jcu.21953
- Hopper I, Skiba M, Krum H. Updated meta-analysis on antithrombotic therapy in patients with heart failure and sinus rhythm. Eur J Heart Fail. 2013;15(1):69-78. doi:10.1093/eurjhf/hfs171
- Velangi PS, Choo C, Chen KA, ve ark. Long-term embolic outcomes after detection of left ventricular thrombus by late gadolinium enhancement cardiovascular magnetic resonance imaging: A matched cohort study. Circ Cardiovasc Imaging. 2019;12(11):e009723. doi:10.1161/CIRCIMAGING.119.009723
- You J, Wang X, Wu J, ve ark. Predictors and prognosis of left ventricular thrombus in post-myocardial infarction patients with left ventricular dysfunction after percutaneous coronary intervention. J Thorac Dis. 2018;10(8):4912-4922. doi:10.21037/jtd.2018.07.69
- Zannad F, Stough WG, Regnault V, ve ark. Is thrombosis a contributor to heart failure pathophysiology? Possible mechanisms, therapeutic opportunities, and clinical investigation challenges. Int J Cardiol. 2013;167(5):1772-82. doi:10.1016/j.ijcard.2012.12.018
- Jiwani S, Mustafa U, Desai S, Dominic P. Survival benefit of aspirin in patients with congestive heart failure: A meta-analysis. J Clin Med Res. 2021;13(1):38-47. doi:10.14740/jocmr4389
- Iguchi M, Kato T, Yaku H, ve ark. Ischemic stroke in acute decompensated heart failure: From the KCHF registry. J Am Heart Assoc. 2021;10(21):e022525. doi:10.1161/JAHA.121.022525
- Zhang S, Wang T, Wang H, ve ark. Effects of individualized administration of folic acid on prothrombotic state and vascular endothelial function with H-type hypertension: A double-blinded, randomized clinical cohort study. Medicine (Baltimore). 2022;101(3):e28628. doi:10.1097/MD.0000000000028628
- Cullivan S, Murphy CA, Weiss L, ve ark. Platelets, extracellular vesicles and coagulation in pulmonary arterial hypertension. Pulm Circ. 2021 Jun 4;11(3):20458940211021036. doi: 10.1177/20458940211021036
- Kakar P, Lip GY. Hypertension: endothelial dysfunction, the prothrombotic state and antithrombotic therapy. Expert Rev Cardiovasc Ther. 2007;5(3):441-50. doi:10.1586/14779072.5.3.441
- Amin H, Mohsin S, Aslam M, ve ark. Coagulation factors and antithrombin levels in young and elderly subjects in Pakistani population. Blood Coagul Fibrinolysis. 2012;23(8):745-50. doi:10.1097/MBC.0b013e328358e913
Toplam 26 adet kaynakça vardır.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Proje Numarası | yok |
| Erken Görünüm Tarihi | 3 Aralık 2022 |
| Yayımlanma Tarihi | 10 Aralık 2022 |
| Gönderilme Tarihi | 15 Mart 2022 |
| Kabul Tarihi | 2 Kasım 2022 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 7 Sayı: 4 |
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