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Title: The use of echocardiography in predicting left ventricle thrombus in patients with idiopathic dilated cardiomyopathy at Chris Hani Baragwanath Hospital
Authors: Ferreira Dos Santos, Claudia Marisa Goncalves
Issue Date: 21-Jan-2013
Abstract: Cardiomyopathies and their resultant heart failure (HF) remain a
major cause of cardiovascular morbidity and mortality (Wood and Picard, 2004).
Idiopathic dilated cardiomyopathy (IDCMO) is a primary myocardial disease of
unknown cause, characterized by left ventricular (LV) or biventricular dilatation
and impaired myocardial contractility. Dilated cardiomyopathy (DCMO), along
with rheumatic heart disease and hypertension (HPT), is one of the leading
causes of HF in Africa. In fact, in an epidemiology study of 884 patients in
Soweto, IDCMO was the second major cause of HF. Thirty five percent of
patients in the study, with HF, had IDCMO (Sliwa, Damasceno, Mayosi, 2005).
Methodology: Patients referred to the cardiomyopathy (CMO) clinic at Chris
Hani Baragwanath hospital, situated in the echocardiographic lab, were recruited,
provided they satisfied the exclusion and inclusion criteria and were enrolled after
obtaining voluntary informed consent. From May 2009 to September 2010, 70
patients with IDCMO were recruited for this trial. Patients with DCMO were
identified by means of echocardiographic criteria which included a left ventricular
ejection fraction (LVEF) of less than 45% and an end diastolic dimension (EDD)
of greater than of 52 mm (2D in long parasternal axis).
Results: In the present study the prevalence of left ventricular (LV) thrombus in
patients with IDCMO was 18.6%. When using Univariate logistic regression, the
only independent predictors of LV thrombus formation was LVEF and age.
However, when multivariate logistic regression analysis was applied to the data,
the only predictor with a significant association was age. The reason for this is
not clear. It is postulated that perhaps younger patients have differences in the
pathophysiology of their disease such as a greater smoldering inflammatory
component which may therefore predispose them to thrombus formation. For
example the presence of IL-6 may be important in the formation of LV clot in
cases of LV dysfunction (Sosin, Bhatia, Davis, Lip, 2003). The association
between LVEF and LV thrombus was borderline significant.
Conclusion: The prevalence of LV thrombus formation in this cohort of patients
with IDCMO was 18.6%. Echocardiographic parameters alone cannot predict
which patients are more likely to develop thrombus formation.
Description: Submitted in fulfillment of the requirements for the Degree of Masters in Technology: Cardiology, Durban University of Technology, 2012.
Appears in Collections:Theses and dissertations (Health Sciences)

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