Peripartum Cardiomyopathy Patients with LV Thrombus Have Worst Prognosis

Several cases of left and right ventricular thrombi complicating peripartum cardiomyopathy have been reported. These studies have shown favourable outcomes in these patients when appropriate treatment including anticoagulation is initiated in a timely manner. However, the differences in outcomes of peripartum cardiomyopathy patients with and without LV thrombus remain understudied. Therefore, Dr Kritika Luthra and her team conducted a study to assess the prevalence and impact of LVT in patients with PPCM.

In a retrospective cohort study using the Nationwide Inpatient Sample database, the researchers found 43,534 patients without LVT and 452 patients with LVT. They performed a univariate analysis of all risk factors and outcomes and a multivariable logistic regression analysis of certain variables.

Key findings of the study:

• Upon analysis, the researchers found that the black race was associated with a higher incidence of LV thrombus.
• Common comorbidities observed in the LVT group were smoking, drug abuse, pregnancy-induced hypertension, diabetes with complications, valvular heart disease, connective tissue disorders, coagulopathy, anaemia and depression.
• They found a higher incidence of adverse outcomes such as congestive heart failure, arrhythmias and stroke in the LVT group. Also, noted caucasian race, obesity, preeclampsia were higher in those without LVT.
• They further noted that mean length of hospital stay (9 vs 5 days), in-hospital mortality (3.32% vs 1.41%) and mean hospitalization charges ($85,390 vs $48,033) were higher in those with LVT.
• However, upon multivariate logistic regression, although they noted a higher incidence of stroke in the LVT group (adjusted OR 5.51), they found no significant difference in the in-hospital mortality between the two groups (adjusted OR 1.17).

The authors concluded, " Our study showed that PPCM patients with LV thrombus had worse outcomes with respect to stroke, length of stay and in-hospital mortality. Higher prevalence in patients with black race, complicated diabetes, peripheral vascular disease, valvular disease, coagulopathy, smoking, drug abuse, depression and psychoses calls for special attention to such high-risk groups for aggressive risk factor modification."

For further information:

DOI:https://doi.org/10.1016/j.ajpc.2021.100313