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Randomized Controlled Trial
. 2023 Feb;10(1):148-158.
doi: 10.1002/ehf2.14158. Epub 2022 Sep 21.

Risk factors for intracardiac thrombus in peripartum cardiomyopathy: a retrospective study in China

Kang Fu  1 , Hui Zhang  1 , Naiyi Chen  1 , Yue Hu  1 , Jie Xiao  2 , Xinyu Zhang  1 , Zongwei Lin  1 , Huixia Lu  1 , Xiaoping Ji  1
Affiliations
Randomized Controlled Trial

Risk factors for intracardiac thrombus in peripartum cardiomyopathy: a retrospective study in China

Kang Fu et al. ESC Heart Fail. 2023 Feb.

Abstract

Aims: Peripartum cardiomyopathy (PPCM) are more vulnerable to intracardiac thrombus than other types of cardiomyopathies, although explicit anticoagulant strategy is not sure. Too aggressive anticoagulation therapy can lead to severe bleeding events. Hence, we want to construct a risk stratification model for intracardiac thrombus in PPCM patients.

Methods and results: A total of 159 suspected PPCM cases were initially screened, whereas 123 confirmed cases were enrolled in the final analysis. The study population was randomly assigned as derivation group (N = 83) and validation group (N = 40). The derivation cohort was utilized to develop the model, and the validation cohort was used to internal validate the discriminatory ability of the model. Formation of intracardiac thrombus was detected in 22 patients. After adjusted by multivariable logistic regression analysis, left ventricle ejection fraction (LVEF, OR 0.772, 95% CI 0.665-0.897, P = 0.001), haemoglobin levels (OR 1.050, 95% CI 1.003-1.099, P = 0.038), and thrombocyte counts (OR 1.018, 95% CI 1.006-1.029, P = 0.003) were identified as risk factors independently associated with intracardiac thrombus and were finally included in the tentative risk stratification model with a C-indexes of 0.916 (95% CI: 0.850-0.982, P < 0.001). A score of ≤7 was regarded as low risk, 8-10 defined intermediate risk, and ≥11 defined high risk in our model. Internal validation showed good discriminatory ability of the model with a C-indexes of 0.790 (95% CI: 0.644-0.936, P = 0.017).

Conclusions: In our retrospective study, impaired LVEF, elevated haemoglobin levels, and high thrombocyte counts were regarded as independent risk factors for intracardiac thrombus in PPCM. A risk stratification model derived from these risk factors, which was economic and easily applicable in clinical practice, could rapidly and accurately identify PPCM patients with higher-risk of intracardiac thrombus.

Keywords: Anticoagulant therapy; Heart failure; Intracardiac thrombus; Peripartum cardiomyopathy; Risk stratification.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Study flow chart and cohort development. HF, heart failure; LVEF, left ventricular ejection fraction; PPCM, peripartum cardiomyopathy.
Figure 2
Figure 2
Transthoracic echocardiogram images of left ventricle (A) and right ventricle (B) intracardiac mural thrombus.
Figure 3
Figure 3
Risk factors enrolled in the risk stratification model after adjusted by multivariable logistic regression analysis. ICT, intracardiac thrombus; LVEF, left ventricular ejection fraction; OR, odd ratios.
Figure 4
Figure 4
ROC curve and DCA curve in the derivation cohort and validation cohort. (A) and (C) for derivation group, (B) and (D) for validation group. AUC, area under curve; DCA, decision curve analysis; ROC, receiver operating characteristic.
See this image and copyright information in PMC

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