Objective To explore the influencing factors of left ventricular thrombus(LVT)in patients with non-ischemic heart failure(NIHF)and to construct a nomogram prediction model for NIHF patients with LVT.Methods This study was a case-control study.A total of 2 592 patients with NIHF hospitalized in Beijing Anzhen Hospital affiliated to Capital Medical University from January 2018 to July 2022 were selected.Fifty-one patients with LVT identified by echocardiography and cardiac magnetic resonance were classified into LVT group.One hundred and sixty patients were selected as the non-LVT group using a 1∶3 propensity score matching based on age and gender.Multivariate logistic regression analysis was used to explore the influencing factors of LVT in patients with NIHF.A nomogram prediction model was constructed,and the area under(AUC)the receiver operating characteristic(ROC)curve was calculated to evaluate the predictive effect of the model.Results A total of 211 patients were enrolled,with a median age of 40 years old and 160 males(76％).Compared with non-LVT group,LVT group had lower systolic blood pressure((112±20)mmHg vs.(120±19)mmHg;1 mmHg=0.133 kPa),lower left ventricular ejection fraction(LVEF;(27±12)％vs.(39±14)％),lower proportion of patients with history of hypertension(28％(14/51)vs.44％(70/160))and atrial fibrillation(8％(4/51)vs.39％(62/160)),higher proportion of patients with New York Heart Association functional class Ⅲ to Ⅳ(class Ⅲ:59％(30/51)vs.41％(66/160);class Ⅳ:28％(14/51)vs.19％(31/160)),and larger left ventricular end-systolic diameter(LVESD;(56±14)mm vs.(50±15)mm).The levels of hemoglobin((152±23)g/L vs.(142±30)g/L),D-dimer(508(300,1 105)μg/L vs.158(68,379)μg/L),and N-terminal pro-brain natriuretic peptide(3 429(2 462,4 734)ng/L vs.1 288(422,2 544)ng/L)were higher in LVT group than in non-LVT group(P all＜0.05).LVT group had a higher proportion of patients using beta-blockers(92％(47/51)vs.78％(124/160)),angiotensin-converting enzyme inhibitors or angiotensin receptor blockers or angiotensin receptor neprilysin inhibitors(88％(45/51)vs.72％(115/160)),and anticoagulant drugs(98％(50/51)vs.32％(51/160))than non-LVT group(all P＜0.05).Multivariate logistic regression showed that reduced LVEF(OR=1.08,95％CI 1.02-1.15,P=0.008),decreased LVESD(OR=1.07,95％CI1.01-1.12,P=0.013),and increased D-dimer levels(OR=5.40,95％CI 1.98-14.74,P=0.001)were independent influencing factors for LVT in patients with NIHF.The ROC curve showed that the AUC of the nomogram for predicting LVT in patients with NIHF was 0.793(95％CI 0.710-0.876,P＜0.001).Conclusion Reduced LVEF,decreased LVESD,and elevated D-dimer are associated with LVT in NIHF patients.The predictive model developed based on the above indicators has certain value in predicting LVT in NIHF patients.
维普
万方数据