| Part 1:A review of studies on heart failure complicated with intracardiac thrombosisHeart failure(HF)with intracardiac thrombosis(ICT)is associated with embolic events.ICT is considered as one of the important sources of emboli for embolic events in patients with HF.Because patients with HF can present hypercoagulant state,coupled with HF changes in the structure of the heart,abnormal blood flow and some causes of special factors,HF patients are more likely to occur in the heart thrombosis.At present,echocardiography is the most common diagnostic technique for ICT,new diagnostic techniques and indicators,such as peak atrial longitudinal strain,3D trans-esophageal echocardiography,and intracardiac echocardiography,have improved the diagnostic rate and prediction rate of ICT.At present,the treatment for HF complicated with ICT is mainly anticoagulant therapy,but the specific treatment course and the prevention of ICT are still unclear.Part 2:Clinical characteristics of patients with heart failure complicated by intracardiac thrombosisObjective:Heart failure(HF)combined with intracardiac thrombosis(ICH)can lead to severe systemic arterial embolism,death or disability,so it is necessary to study the clinical characteristics of this patient group.In this study,the clinical characteristics and thrombosis distribution characteristics of patients diagnosed with HF complicated with intracarac thrombosis admitted to Fuwai Hospital since 2008 were summarized and analyzed,aiming to explore the pathogenesis characteristics of this patient group.Methods:To review the patient records of Fuwai hospital heart failure care unit from October 2008 to May 2018.Patients withICT complicated with HF were continuously screened for discharge diagnosis using keywords such as "ntracardiac thrombosis" or "intracardiac thrombosis" or "atrial thrombosis" or "ventricular thrombosis" or "auricular thrombosis"or "mural thrombosis" and "cardiac function" or"heart failure".Baseline information of patients was collected,including age,sex,vital signs,complications,laboratory tests,information on intracarac thrombosis,and information on cardiac diameter,left ventricular ejection fraction,and medication.The characteristics of baseline conditions of patients with HF complicated withICT and the relationship between the distribution ofICT and the diagnosis of basic heart disease and cardiac function were analyzed.Meanwhile,the application of anticoagulant drugs in this population was analyzed and summarized.RESULTS:A total of 1248 patients were enrolled in this study,among whom 72.2%were male.In general,the number of thrombosis in the left heart was more than that in the right heart,and the number of thrombosis in the ventricle was more than that in the atrium in patients with HF.The left ventricle was the heart cavity with the most thrombosis in the four chambers(66.8%).Transthoracic echocardiography was the main way to diagnose HF complicated withICT(75.1%).Studies have found that the location of thrombosis is related to complications and cardiac function.In patients with HF complicated with coronary heart disease,myocardial densification insufficiency and dilated cardiomyopathy,cardiac thrombosis mostly occurs in the left ventricle.HF complicated with atrial fibrillation/flutter,hypertrophic cardiomyopathy,restrictive cardiomyopathy,and valvular heart disease.The main site ofICT was the left atrium.The lower the LVEF,the higher the cardiac function grade,and the higher the distribution rate of left ventricular thrombosis(trend test P<0.0001),while the distribution pattern of left atrial thrombosis is opposite(trend test P<0.0001).The inner diameter of the left ventricle and left atrium were both related to the occurrence of thrombus in the heart cavity,and the inner diameter of the heart cavity of the patients with thrombus was significantly higher than that of the patients without thrombus(P<0.0001).In this study,the total utilization rate of anticoagulants in enrolled patients was 56.8%,and warfarin was the main drug(45.1%).Conclusion:ICT is not uncommon in patients with HF,and the distribution of thrombosis has certain regularity,especially the left ventricle is the most common site of thrombosis in patients with HF,which should be paid more attention in clinical work.Part 3:Clinical Characteristics of Patients With Dilated Cardiomyopathy Complicated With Intracardiac ThrombosisObjectives:To investigate the clinical characteristics of patients with dilated cardiomyopathy(DCM)complicated with intracardiac thrombosis,and to provide data basis for further study of intervention therapy.Methods:Patients discharged from Fuwai Hospital from April 2007 to June 2018 were selected continuously,and patients diagnosed with "dilated cardiomyopathy" or"pregnancy cardiomyopathy" or "alcohol cardiomyopathy" complicated with"intracardiac thrombosis" were enrolled.Results:A total of 277 patients were enrolled.Intracardiac thrombosis in DCM patients mainly occurred in the left ventricle(77.6%),followed by the left atrium(20.2%).The incidence of left ventricular thrombosis was highest(83.3%and100%)with noncompaction of the ventricular myocardium and peripartum cardiomyopathy.The distribution of left ventricular thrombosis was more in patients with severe reduction of left ventricular ejection fraction and worse cardiac function,while the distribution of left atrial thrombosis was on the contrary.69.3%of the patients received oral anticoagulants,and warfarin was the most commonly used anticoagulant.Conclusions:The distribution characteristics of DCM with intracardiac thrombosis are regular,and the left ventricle is the most common site of thrombosis,which should be paid more attention in clinical work.Part 4:Clinical characteristics of hypertrophic cardiomyopathy and restricted cardiomyopathy with intracardiac thrombosisObjective:To investigate the clinical characteristics of patients with hypertrophic cardiomyopathy(HCM)and restrictive cardiomyopathy(RCM)complicated with intracardiac thrombosis,and to provide data basis for further study of intervention therapy.Methods:Patients discharged from Fuwai Hospital from September 2008 to September 2020 were selected continuously,and patients diagnosed with "hypertrophic cardiomyopathy" or "restrictive cardiomyopathy" complicated with "intracardiac thrombosis" were enrolled.Patients with myocardial infarction were excluded.Results:A total of 98 patients were enrolled in the study,including 52 patients with HCM and 46 patients with RCM.Intracardiac thrombosis mainly occurred in the left atrium(71.4%),patients with HCM had a higher rate of left ventricular thrombosis(19.2%)and patients with RCM had a higher rate of right atrial thrombosis(30.4%).The rate of left atrial thrombosis in patients with atrial fibrillation/fluttering was 81.6%,and the rate of left ventricular thrombosis in patients with ventricular aneurysm was 80.0%.Left ventricular thrombosis was more distributed in patients with significantly reduced LVEF,while the distribution pattern of left atrial thrombosis was opposite.In this study,78.5%of patients received oral anticoagulants,with warfarin being the most commonly used oral anticoagulant.Conclusion:The distribution characteristics of HCM and RCM patients with intracarac thrombosis are regular,and the left atrium is the most common site of thrombosis,which should be paid more attention in clinical work. |
PDF Full Text Request