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S. Tongsai

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Open access Jul 2026

Determinants, risk score, and prognostic implications of left ventricular thrombus in ischemic cardiomyopathy assessed by cardiac magnetic resonance: a retrospective cohort study

Abstract Background Left ventricular thrombus (LVT) is a significant complication in ischemic cardiomyopathy (ICM). However, factors associated with LVT have mainly been reported in patients with recent myocardial infarction (MI), while data in chronic ICM remain limited. This study aimed to identify factors associated with CMR-detected LVT in patients with chronic ICM (left ventricular ejection fraction [LVEF] < 50% of ischemic etiology, >40 days post-MI), develop a CMR-based risk score, and evaluate the prognostic implications of LVT on major adverse cardiovascular events (MACE). Methods This study included 790 patients with ICM who underwent CMR at an academic hospital in Thailand between 2016 and 2023. Factors associated with LVT were identified using logistic regression analyses. A CMR-based risk score was developed and validated, with discriminative performance assessed by the area under the receiver operating characteristic curve (AUC-ROC). MACE, defined as a composite of cardiovascular death, ischemic stroke, transient ischemic attack, systemic embolism, nonfatal MI, or heart failure hospitalization, was also evaluated. Factors associated with MACE were assessed using Cox regression analysis. Results The mean age was 66.9 ± 11.3 years, and 75.3% were male. LVT was detected in 116 patients. Independent factors associated with LVT included apical aneurysm, apical late gadolinium enhancement (LGE), and the number of LGE segments. The CMR-LVT Score, incorporating these variables, demonstrated an AUC of 0.73 (95%CI, 0.68–0.77;p < 0.001) in the derivation cohort and 0.79 (95%CI, 0.69–0.90;p < 0.001) in the validation cohort. During a median follow-up of 3.2 years (IQR, 1.6–5.5), 150 MACE occurred. Baseline LVT was independently associated with MACE (adjusted HR 2.38, 95%CI 1.31–4.30;p = 0.004). Conclusions In patients with ICM undergoing CMR, apical aneurysm, apical LGE, and LGE extent were independently associated with LVT. The CMR-LVT Score demonstrated acceptable discriminative performance for identifying higher-risk patients who may benefit from more intensive follow-up. LVT was also independently associated with MACE.

Chayathorn Aramcharoen, P. Buraphat, Thidanan Wanitanantakun et al. · 0 citations
Open access Aug 2026

Left ventricular stroke volume index predicts outcomes in asymptomatic chronic severe primary mitral regurgitation

Severe primary mitral regurgitation (MR) linked to substantial morbidity and mortality. However, racial differences impact the left ventricular size, which subsequently influence specific echocardiographic parameters. In this context, the left ventricular stroke volume index (LVSVi) may serve as a valuable prognostic indicator. This study aims to examine the association between LVSVi and a composite endpoint of all-cause mortality or mitral valve (MV) surgery. We conducted a retrospective study on asymptomatic chronic severe primary MR patients over a 5-year follow-up period. Among 77 patients with asymptomatic severe primary MR (mean age, 56.9 years; 55 male patients, 71.4%), an increase of 1 mL/m2 in LVSVi, calculated from the left ventricular outflow tract area, was independently associated with an 8.2% reduction in the odds of reaching the composite endpoint of all-cause mortality or MV surgery (adjusted odds ratio, 0.918; 95% confidence interval, 0.856–0.986; P = 0.018). The receiver operating characteristic curve for LVSVi demonstrated an area under the curve of 0.726 (P = 0.002), with a threshold of ≤ 35 mL/m2 yielding a sensitivity of 81% and specificity of 50% for predicting the composite outcome. The 5-year event-free survival was significantly lower in patients with LVSVi ≤ 35 mL/m2 compared to those with LVSVi > 35 mL/m2 (22.9% vs. 67.0%; Breslow test, P < 0.001). In patients with asymptomatic chronic severe primary MR, LVSVi was the significant echocardiographic parameter influencing the outcomes of MV surgery and mortality. This study supported the hypothesis generation that LVSVi may serve as a prognostic marker in this specific population.

P. Sethalao, N. Ratanasit, D. Jakrapanichakul et al. · 0 citations