Risk factors and outcomes associated with Left Ventricular Thrombus in patients with Peripartum Cardiomyopathy: An insight from National Inpatient Sample Database

Kritika Luthra; Sindhu R Avula; Murugesan Raju; Karthik Gangu; Zainulabedin Waqar; Rajiv Doddamani; Bhanu Harshita Settipalle; Jay Shah; Syed Sohail Ali; Hemindermeet Singh

doi:10.1016/j.ajpc.2021.100313

Risk factors and outcomes associated with Left Ventricular Thrombus in patients with Peripartum Cardiomyopathy: An insight from National Inpatient Sample Database

Am J Prev Cardiol. 2021 Dec 24:9:100313. doi: 10.1016/j.ajpc.2021.100313. eCollection 2022 Mar.

Affiliations

¹ Mercy St. Vincent Medical Center, Toledo, OH, USA.
² University of Kansas Medical Center, Kansas City, Kansas, USA.
³ University of Missouri, Columbia, Missouri, USA.
⁴ Ochsner Health, Slidell, Louisiana, USA.
⁵ University of Illinois, Chicago, Illinois, USA.

Abstract

Background: : We sought to assess the prevalence and impact of left ventricular thrombus (LVT) in patients with peripartum cardiomyopathy (PPCM).

Methods: : We performed a retrospective cohort study of all admissions with PPCM as the primary diagnosis from the Nationwide Inpatient Sample database over a 11-year period. Univariate analysis of all risk factors and outcomes and multivariable logistic regression analysis of certain variables were performed and represented as odds ratio (OR) with 95% confidence interval (CI). A p value of < 0.05 was considered statistically significant. Statistical analysis was performed using epiDisplay in 'R' studio.

Results: : In the time frame spanning 2005 -2014, 43,986 admissions with PPCM were found which included 43,534 without LVT and 452 patients with LVT. Black race was associated with a higher incidence of LV thrombus, (p value <0.001). Comorbidities more prevalent in the LVT group were smoking, drug abuse, pregnancy induced hypertension, diabetes with complications, valvular heart disease, connective tissue disorders, coagulopathy, anemia and depression. Adverse outcomes such as congestive heart failure, arrhythmias and stroke were higher in LVT group. Conversely, Caucasian race, obesity, preeclampsia (p <0.005) were higher in those without LVT. Mean length of stay (9 vs 5 days, p <0.001), in hospital mortality (3.32% vs 1.41%, p = 0.001) and mean hospitalization charges ($85,390 vs $48,033) were higher in those with LVT. However, on multivariate logistic regression, although stroke was higher in the LVT group (adjusted OR 5.51, 95% CI, 2.2, 13.81, 5.05, p 0.002), in-hospital mortality was not significantly different between the two groups (adjusted OR 1.17, 95% CI,0.32, 4.23, p = 0.817).

Conclusion: : 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.

Keywords: AHRQ, Agency for Healthcare Research and Quality; CI, Confidence Interval; Epidemiology; ICD, International Classification of Diseases; In- hospital stay; LHC, Left Heart Catheterization; LOS, Length of Stay; LVEF, Left Ventricular Ejection Fraction; LVT, Left Ventricular Thrombus; Left ventricular thrombus; Mortality; NIS, National Inpatient Sample; NYHA, New York Heart Association; PPCM, Peripartum Cardiomyopathy; Peripartum cardiomyopathy; RHC, Right Heart Catheterization; Risk of stroke; Smoking, obesity.