warfarin and Cardiomyopathies

Topics: Acute Kidney Injury; Adult; Aged; Aged, 80 and over; Atrial Fibrillation; Azetidines; Cardiomyopathies; Ezetimibe; Female; Heart Failure; Humans; Kidney Failure, Chronic; Male; Middle Aged; Pyrazoles; Pyridones; Recurrence; Risk; Seizures; Simvastatin; Ultrasonography; Warfarin

Peripartum cardiomyopathy is a life-threatening condition of unknown cause that occurs in previously healthy women during the peripartum period. It is characterized by left ventricular dysfunction and symptoms of heart failure that can arise in the last trimester of pregnancy or up to 5 months after delivery. We review its possible causes and how to recognize and manage it.

Topics: Abnormalities, Drug-Induced; Angiotensin-Converting Enzyme Inhibitors; Anticoagulants; Cardiomyopathies; Contraindications; Female; Heart Failure; Heart Transplantation; Humans; Postpartum Period; Pregnancy; Pregnancy Complications, Cardiovascular; Recurrence; Risk Factors; Ventricular Dysfunction, Left; Warfarin

Isolated left ventricular noncompaction (IVNC) is a congenital cardiomyopathy characterized by a loosened spongy myocardium. Recognition of this condition is extremely important because of its high mortality and morbidity due to progressive heart failure, thromboembolic events, and ventricular arrhythmias. However, IVNC is commonly misdiagnosed because of the lack of knowledge about this rare disorder. We report 2 patients with the characteristic echocardiographic presentation for IVNC. Echocardiography is the procedure of choice to confirm the diagnosis and perform follow-up in patients with IVNC; therefore, it is important to make echocardiographers more familiar with this condition.

Topics: Anticoagulants; Carbazoles; Cardiomyopathies; Carvedilol; Diagnosis, Differential; Echocardiography; Electrocardiography; Humans; Male; Middle Aged; Propanolamines; Vasodilator Agents; Ventricular Dysfunction, Left; Warfarin

The current published literature does not indicate whether the long-term effect of anticoagulant or antiplatelet therapy contributes to mortality reduction in patients with LV dysfunction. Evaluating patients for personal risk for emboli or for ischemic coronary artery events may influence the choice of therapies. As more is learned about the mechanisms of drug effects in different populations, physicians may be better able to direct appropriate therapies. Until that time, one must weigh the risks and benefits of each drug alone and in combination. In NYHA class IV patients, the risk for thrombosis owing to spontaneous clotting increases as does the adverse potential of warfarin and the adverse effects of inhibiting prostaglandin mediated vasodilation by aspirin. In NYHA class I and II patients, the quality of life and convenience of multidrug therapy is weighed against the devastating effect of a major stroke. In less symptomatic patients, the long-term risk for acute coronary events may be higher than previously identified. This would suggest that all patients with depressed LV function should be on some type of antiplatelet or anticoagulant therapy. The current WATCH study will provide much needed information about the outcome differences between these agents. Conclusions based on available data include the following: Heart failure is increasing in incidence and prevalence. Atherosclerotic disease is an important causative factor for the development of heart failure or may be a comorbid condition in these patients. There is a measurable rate of stroke in patients with heart failure, although the cause of death in large studies is more often owing to sudden death or progressive heart failure. Sudden death may be from new ischemic events, asystole, or from ventricular tachyarrhythmias. In patients with heart failure, not all strokes are cardioembolic in origin. The benefits and risks of warfarin may be increased as the EF worsens or heart failure functional class declines. The interactions of aspirin and ACE inhibitors have been best evaluated for the hemodynamic effects. There may be additional factors hitherto not studied. The hemodynamic effect of ACE inhibitors may be more important in NYHA classes III and IV than in less symptomatic patients. Warfarin use has clear indications for patients in atrial fibrillation with mechanical prosthetic valves, in hypercoagulable states, and with a previous history of embolization. Aspirin is inexpensive and commo

Topics: Anticoagulants; Cardiomyopathies; Comorbidity; Heart Failure; Humans; Life Style; Stroke; Ventricular Dysfunction, Left; Warfarin

Systemic embolic complications in patients with cardiomyopathy are associated with significant morbidity and mortality. Despite the lack of prospective, randomized control data, the literature supports the use of left ventricular ejection fraction as an important determinant of the need for systemic anticoagulation therapy in patients with systolic dysfunction. This review discusses the risks and benefits of systemic anticoagulation for patients with cardiomyopathy and proposes a treatment algorithm for its initiation.

Topics: Algorithms; Anticoagulants; Cardiomyopathies; Humans; Intracranial Embolism; Randomized Controlled Trials as Topic; Stroke; Stroke Volume; Ventricular Dysfunction, Left; Warfarin

There is debate on whether the beneficial effect of implantable cardioverter-defibrillators (ICDs) is attenuated in patients with non-ischaemic cardiomyopathy (NICM). We assess whether any ICD benefit differs between patients with NICM and those with ischaemic cardiomyopathy (ICM), using data from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial.. We performed a post hoc analysis using WARCEF (N = 2293; ICM, n = 991 vs. NICM, n = 1302), where participants received optimal medical treatment. We developed stratified propensity scores for having an ICD at baseline using 41 demographic and clinical variables and created 1:2 propensity-matched cohorts separately for ICM patients with ICD (N = 223 with ICD; N = 446 matched) and NICM patients (N = 195 with ICD; N = 390 matched). We constructed a Cox proportional hazards model to assess the effect of ICD status on mortality for patients with ICM and those with NICM and tested the interaction between ICD status and aetiology of heart failure. During mean follow-up of 3.5 ± 1.8 years, 527 patients died. The presence of ICD was associated with a lower risk of all-cause death among those with ICM (hazard ratio: 0.640; 95% confidence interval: 0.448 to 0.915; P = 0.015) but not among those with NICM (hazard ratio: 0.984; 95% confidence interval: 0.641 to 1.509; P = 0.941). There was weak evidence of interaction between ICD status and the aetiology of heart failure (P = 0.131).. The presence of ICD is associated with a survival benefit in patients with ICM but not in those with NICM.

Topics: Aged; Anticoagulants; Aspirin; Cardiomyopathies; Cause of Death; Defibrillators, Implantable; Echocardiography; Female; Follow-Up Studies; Heart Failure; Heart Ventricles; Humans; Male; Middle Aged; Platelet Aggregation Inhibitors; Propensity Score; Radionuclide Ventriculography; Retrospective Studies; Risk Factors; Stroke Volume; Survival Rate; United States; Ventricular Function, Left; Warfarin

Topics: Aged; Aged, 80 and over; Amyloidosis; Anticoagulants; Antithrombins; Atrial Fibrillation; Cardiomyopathies; Dabigatran; Factor Xa Inhibitors; Female; Heart Failure; Humans; Male; Pyrazoles; Pyridones; Rivaroxaban; Stroke; Warfarin

A 38-year-old woman with peripartum cardiomyopathy underwent placement of a HeartMate 3 (HM3) left ventricular assist device (LVAD). Postoperatively, she refused warfarin therapy and was maintained on aspirin monotherapy for 19 months. She did not experience thrombotic or thromboembolic complications associated with lack of oral vitamin K antagonist anticoagulation. Our patient represents the longest reported duration of a patient with HM3 LVAD maintained without warfarin without evidence of thrombotic or thromboembolic events.

Topics: Adult; Anticoagulants; Aspirin; Cardiomyopathies; Female; Heart Ventricles; Heart-Assist Devices; Humans; Thromboembolism; Time Factors; Treatment Refusal; Warfarin; Withholding Treatment

Topics: Anticoagulants; Aorta; Aortic Valve; Cardiomyopathies; Coronary Sinus; Echocardiography; Echocardiography, Transesophageal; Female; Heart Transplantation; Heart-Assist Devices; Humans; Middle Aged; Thrombosis; Warfarin

Topics: Anticoagulants; Brachiocephalic Veins; Cardiomyopathies; Defibrillators, Implantable; Edema; Face; Heparin; Humans; Jugular Veins; Male; Middle Aged; Treatment Outcome; Ultrasonography, Doppler, Color; Venous Thrombosis; Warfarin

Topics: Adult; Anticoagulants; Cardiomyopathies; Chest Pain; Coronary Angiography; Coronary Occlusion; Drug-Eluting Stents; Dyspnea; Echocardiography; Electrocardiography; Heart Diseases; Heart Transplantation; Humans; Male; Myocardial Ischemia; ST Elevation Myocardial Infarction; Thrombosis; Ventricular Dysfunction, Left; Warfarin

Acute renal infarction is a rare entity with varied misleading manifestations resulting in diagnostic delay, misdiagnosis, and treatment leading to renal damage.. We report the case of a 28-year-old Dalit Nepalese man who presented with sudden onset occipital headache and later developed severe left flank pain. He was diagnosed with posterior cerebral infarction with hemorrhagic transformation and a subsequent acute renal infarction with atrial fibrillation and hyperthyroid-induced cardiomyopathy. He was managed with oral anticoagulant and antithyroid drug.. A high index of suspicion of acute renal infarction is required in patients with risk factors of thrombosis presenting sudden onset flank pain.

Topics: Adrenergic beta-Antagonists; Adult; Angiography; Anticoagulants; Antithyroid Agents; Atrial Fibrillation; Carbimazole; Cardiomyopathies; Echocardiography; Humans; Hyperthyroidism; Infarction; Kidney Diseases; Male; Stroke; Tomography, X-Ray Computed; Warfarin

Sustained growth in the arrhythmia population at Stanford Health Care led to an independent nurse practitioner-run outpatient direct current cardioversion (DCCV) program in 2012. DCCVs performed by a medical doctor, a nurse practitioner under supervision, or nurse practitioners from 2009 to 2014 were compared for safety and efficacy. A retrospective review of the electronic medical records system (Epic) was performed on biodemographic data, cardiovascular risk factors, medication history, procedural data, and DCCV outcomes. A total of 869 DCCVs were performed on 557 outpatients. Subjects were largely men with an average age of 65 years; 1/3 were obese; most had atrial fibrillation; and majority of subjects were on warfarin. The success rate of the DCCVs was 93.4% (812 of 869) with no differences among the groups. There were no short-term complications: stroke, myocardial infarction, or death. The length of stay was shortest in the NP group compared to the other groups (p <0.001). In conclusion, the success rate of DCCV in all groups was extremely high, and there were no complications in any of the DCCV groups.

Topics: Aged; Aged, 80 and over; Ambulatory Care; Anticoagulants; Atrial Fibrillation; Cardiomyopathies; Comorbidity; Diabetes Mellitus, Type 2; Electric Countershock; Female; Humans; Hypertension; Length of Stay; Male; Middle Aged; Nurse Practitioners; Obesity; Patient Safety; Physicians; Practice Patterns, Nurses'; Retrospective Studies; Stroke; Treatment Outcome; Warfarin

Although atrial fibrillation (AF) is a known complication of amyloidotic cardiomyopathy (AC), a precise pathophysiological and prognostic characterization is not available. We therefore aimed to assess prevalence, incidence, risk factors and prognostic significance of AF in light-chain (AL), hereditary transthyretin-related (m-ATTR) and non-mutant transthyretin-related (wt-ATTR) AC.. Retrospective study of 262 patients with AC (123 AL, 94 m-ATTR, 45 wt-ATTR) from a single center.. AF prevalence was 15% (AL 9%, m-ATTR 11%, wt-ATTR 40%). During a median follow-up of 1.2 years 11 patients developed AF (2.1% person-years). Age, heart failure (HF), left ventricular (LV) ejection fraction, renal involvement, left atrial size and right atrial pressure were independently associated with AF. AF was associated with incident HF but not with increased mortality. All AF patients were prescribed warfarin and none suffered thromboembolic events.. In AC the prevalence of AF varies widely according to etiology with a mean value of 15% that reaches 40% in wt-ATTR amyloidosis. Age, HF, LV ejection fraction, left atrial size and right atrial pressure were the main independent risk factors, while wall thickness and etiology were not the main independent risk factors. AF does not seem to impact all-cause mortality but was strongly associated with prevalent and incident HF.

Topics: Administration, Oral; Aged; Aged, 80 and over; Amyloidosis; Anticoagulants; Atrial Fibrillation; Cardiomyopathies; Female; Heart Failure; Humans; Incidence; Italy; Longitudinal Studies; Male; Middle Aged; Prealbumin; Prevalence; Prognosis; Retrospective Studies; Risk Assessment; Risk Factors; Stroke Volume; Survival Analysis; Thromboembolism; Ventricular Function, Left; Warfarin

Topics: Anticoagulants; Blood Coagulation Factors; Cardiomyopathies; Cardiopulmonary Bypass; Factor VII Deficiency; Heart-Assist Devices; Humans; Male; Middle Aged; Ventricular Dysfunction, Left; Warfarin

An 85-year-old man with persistent atrial flutter (AFL) with slow ventricular rate of 44/min, causing fatigue and presyncope, was referred for urgent treatment. In spite of thromboembolic risk scale value 4, he had not been treated with anticoagulants because of high risk of bleeding. The decision was made to perform urgent catheter ablation to interrupt and cure AFL. Intracardiac echocardiography probe was placed in the pulmonary artery and visualized left atrial appendage free from thrombus with its proper function. Heparin was administered and AFL stopped during energy application. Intracardiac echocardiography showed immediate thrombus formation in left atrial appendage owing to complete atrial standstill and no retrograde conduction during hemodynamically effective escape nodal rhythm. This case report shows that in patients with sinus node disease effective ablation of AFL with escape rhythm without retrograde conduction to the atria may result in complete 'electrically induced' atrial standstill and immediate thrombus formation.

Topics: Aged, 80 and over; Anticoagulants; Atrial Flutter; Brugada Syndrome; Cardiac Conduction System Disease; Cardiomyopathies; Catheter Ablation; Echocardiography, Transesophageal; Fatigue; Genetic Diseases, Inborn; Heart Atria; Heart Block; Heart Ventricles; Heparin, Low-Molecular-Weight; Humans; Male; Syncope; Thrombosis; Warfarin

Cardiomyopathy is a common cause of heart failure in children. Thrombosis is a potential significant secondary complication. Thus warfarin is recommended by the American College of Chest Physicians for the treatment of children with cardiomyopathy despite the lack of published evidence to support its use.. A retrospective clinical audit to estimate the rates of major bleeding and incidence of thromboembolism associated with oral anticoagulant therapy (warfarin) for primary thromboprophylaxis in a cohort of children with cardiomyopathy. Relevant outcomes including thrombosis and major haemorrhage were defined a priori according to internationally accepted definitions.. 36 children (35.9 warfarin years) were examined, with 25% taking warfarin for greater than 1year. Primary reasons for discontinuation of warfarin therapy were cardiac transplantation (n=7), transition to VAD (n=1), improved cardiac function (n=17), transfer of care (n=3), change to aspirin (n=2). The mean age at starting warfarin was 5.4years (range 0.2-15.2). The most common Target Therapeutic Range (TTR) for warfarin therapy was 2.0 - 3.0. TTR achievement was normally distributed and occurred in a mean 48.5% of all INR tests. There were zero warfarin related adverse events, including thrombosis or haemorrhage.. The low rate of TTR achievement is consistent with previously reported TTR achievement rates for infants. In addition the low rate of TTR achievement was likely influenced by the clinical profile of this complicated condition in children. Nonetheless, this data shows that the clinical outcomes for this cohort are acceptable and warfarin therapy can be safe in children with cardiomyopathy.

Topics: Adolescent; Anticoagulants; Blood Coagulation; Cardiomyopathies; Child; Female; Hemorrhage; Humans; Incidence; International Normalized Ratio; Male; Retrospective Studies; Thromboembolism; Thrombosis; Warfarin

A 22-year old woman visited the LAMB Hospital, Parbatipur, Dinajpur, Bangladesh, in February 2010, with exertional dyspnea for three weeks. She had had a normal vaginal delivery four months ago; 2-dimensional echocardiogram showed severe left ventricular dysfunction and biventricular thrombi, which resolved without complications after anticoagulation. Biventricular thrombosis with peripartum cardiomyopathy is quite a rare finding, and its clinical course and proper management is not known. No such case has previously been reported in Bangladesh.

Topics: Bangladesh; Cardiomyopathies; Drug Combinations; Echocardiography; Enalapril; Female; Furosemide; Humans; Peripartum Period; Puerperal Disorders; Thrombosis; Ventricular Dysfunction, Left; Warfarin; Young Adult

Patients rarely consult physicians before developing coagulopathy or bleeding in most reported cases of superwarfarin intoxication. A 57-year-old woman ingested red-dyed pellets of anticoagulant rodenticide containing difethialone and warfarin as well as tablets of nitrazepam. Although she presented to the hospital in a comatose state, notable pink-colored excreta hinted at the consumption of anticoagulant rodenticide, which led to the early diagnosis of superwarfarin intoxication. Supplementation of large doses of intravenous and oral vitamin K successfully prevented coagulopathy and bleeding. On the other hand, temporary and reversible myocardial suppression was extremely severe, and required the introduction of percutaneous cardiopulmonary support.

Topics: 4-Hydroxycoumarins; Anticoagulants; Cardiomyopathies; Coloring Agents; Female; Humans; Intra-Aortic Balloon Pumping; Middle Aged; Nitrazepam; Rodenticides; Vitamin K; Warfarin

Topics: Calcinosis; Cardiomyopathies; Fatal Outcome; Female; Humans; Middle Aged; Pericarditis; Warfarin

Warfarin has been shown to accelerate vascular calcification in experimental animals, and possibly humans, through inhibition of the vitamin K-dependent protein matrix gla protein, a potent inhibitor of tissue calcification. We performed a cross-sectional analysis of the extent of coronary artery calcification (CAC) in patients without coronary heart disease, currently taking or referred for warfarin therapy. The primary end point was severity of CAC measured by electron beam computed tomography attributed to duration of warfarin use, after adjustment for cardiovascular risk factors. Seventy patients (46 men, mean age 68 +/- 13 years) were enrolled from three groups of warfarin use duration: (1) <6 months (n = 31, mean duration 1 +/- 1 months), (2) 6-24 months (n = 11), and (3) >24 months (n = 28, mean 67 +/- 40 months). Overall, the mean total CAC score (Agatston) was 293 +/- 560: group 1 (175 +/- 285), group 2 (289 +/- 382), and group 3 (426 +/- 789). In univariate analysis, there was a nonsignificant trend to increased CAC with increasing warfarin exposure (P = 0.18). Bivariate analysis revealed no correlation between warfarin duration and CAC score (r = 0.075, P = 0.537). Linear regression for the independent variable coronary calcium score controlling for warfarin treatment duration and intensity (duration of warfarin use months x mean INR), Framingham risk score, and creatinine clearance showed that only the Framingham risk score was associated with CAC (P = 0.001). Among patients without known coronary heart disease, duration of warfarin exposure was not associated with extent of coronary calcification.

Topics: Aged; Aged, 80 and over; Anticoagulants; Calcinosis; Cardiomyopathies; Coronary Angiography; Coronary Artery Disease; Cross-Sectional Studies; Female; Humans; Linear Models; Male; Middle Aged; Risk Factors; Warfarin

Topics: Adrenergic beta-Antagonists; Amiodarone; Anticoagulants; Atrial Fibrillation; Cardiomyopathies; Chest Pain; Humans; Perfusion; Vasodilator Agents; Warfarin

We report successful surgical management of a 31-year-old man with a left ventricular thrombus following heart failure due to cardiac sarcoidosis. Preoperative echocardiography showed diffuse hypokinesis and a mobile ball-like thrombus in the left ventricle. Computed tomography revealed a left ventricular tumor and bilateral hilar lymphadenopathy, while MRI of the brain showed small infarctions in the occipital lobe. Postoperative pathologic examination of a specimen from the left ventricular free wall and a mediastinal lymph node revealed non-caseating granulomas consistent with cardiac sarcoidosis. The patient was referred to a cardiologist for further treatment with prednisolone. This is a rare case of surgical removal of a left ventricular ball-like thrombus in a patient with cardiac sarcoidosis.

Topics: Adult; Anticoagulants; Cardiomyopathies; Cerebral Infarction; Glucocorticoids; Heart Diseases; Heart Failure; Heart Ventricles; Humans; Lymphatic Diseases; Magnetic Resonance Imaging; Male; Occipital Lobe; Prednisolone; Sarcoidosis; Thrombectomy; Thrombosis; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

Isolated noncompaction of the myocardium (INCM) is a rare, congenital, unclassified cardiomyopathy. It is caused by a disorder in endomyocardial morphogenesis in the absence of other structural disease. INCM is characterized by numerous prominent trabeculations and deep intertrabecular recesses in the myocardium. Frequently, INCM is associated with an increased incidence of heart failure, arrhythmias, and cardioembolic events with high morbidity and mortality. We describe a 28-year-old woman experiencing symptoms of heart failure since she was 4 years old. She had been intensively investigated and misdiagnosed as having dilated, restrictive, and apical hypertrophic cardiomyopathies. Cardiac magnetic resonance and echocardiography recently revealed the actual diagnosis of INCM. The patient is alive and well, taking vasodilators and warfarin. Herein, we describe the long-term follow-up of this patient and demonstrate that some patients have a favorable prognosis. In addition, the improvement in noninvasive cardiac imaging has revealed a higher prevalence of INCM, previously undetected.

Topics: Anticoagulants; Cardiomyopathies; Child, Preschool; Diagnosis, Differential; Female; Humans; Longitudinal Studies; Survival Analysis; Time Factors; Ultrasonography; Vasodilator Agents; Ventricular Dysfunction, Left; Warfarin

The long-term effects of axial-flow mechanical circulatory support in humans are unclear. We report 3 cases of chronic gastrointestinal bleeding after implantation of a Jarvik 2000 axial-flow left ventricular assist device. The bleeding was refractory to aggressive management and in 2 cases resolved only after orthotopic cardiac transplantation.

Topics: Aged; Anticoagulants; Arteriovenous Malformations; Cardiomyopathies; Female; Gastrointestinal Hemorrhage; Heart-Assist Devices; Humans; Intestine, Small; Male; Middle Aged; Myocardial Ischemia; Warfarin

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Anticoagulants; Aspirin; Biomarkers; Cardiomyopathies; Chest Pain; Echocardiography; Electrocardiography; Heart Diseases; Heart Ventricles; Heparin; Humans; Male; Platelet Aggregation Inhibitors; Syndrome; Thrombosis; Tomography, X-Ray Computed; Treatment Outcome; Troponin; Warfarin

A 79-year-old woman was admitted for treatment of bronchial asthma. ST-segment elevation in the precordial leads (V4-V6) and T-wave inversion in leads II, III, and aVF was recognized. Transthoracic echocardiography and emergent cardiac catheterization demonstrated two large mobile thrombi (1.2 x 1.3 cm, 0.7 x 1.0 cm) attached to the left ventricular wall. There was no organic stenosis. Left ventriculography revealed anterolateral, apical and inferior dyskinesis, and basal hyperkinesis. The clinical diagnosis was ampulla cardiomyopathy. Anticoagulant therapy was started. Prothrombin time-international normalized ratio was remained at 2.5-3 and partial thromboplastin time was controlled at 1.5-2 times compared with the normal value. Repeated echocardiography showed the mass reduced gradually and had disappeared about 2 weeks later.

Topics: Aged; Anticoagulants; Cardiomyopathies; Echocardiography; Female; Heart Diseases; Heart Ventricles; Heparin; Humans; Thrombosis; Warfarin

Topics: Anticoagulants; Antioxidants; Blood Coagulation Disorders; Cardiomyopathies; Coenzymes; Drug Interactions; Humans; Male; Middle Aged; Ubiquinone; Warfarin

The cause of a fatal condition characterized by hemorrhagic cardiomyopathy, hemothorax, and coagulation defects in hysterectomy-derived male mice was investigated. Microscopic heart alterations included multifocal hemorrhage and necrosis with variable degrees of acute inflammation and fibroplasia that were most severe in the region of the atrioventricular junction. A spontaneous outbreak was arrested by increasing menadione Na-bisulfite (vitamin K) in the feed to 20 ppm. The complete syndrome including hemorrhagic cardiomyopathy was readily reproduced in germ-free male mice given a vitamin K-free diet, and in conventional male and female mice given Warfarin in the diet. We concluded that the cause of this condition was vitamin K deficiency.

Topics: Animals; Blood Coagulation Disorders; Cardiomyopathies; Female; Hemorrhagic Disorders; Hemothorax; Male; Mice; Mice, Inbred C3H; Mice, Inbred C57BL; Mice, Inbred CBA; Myocardium; Vitamin K; Vitamin K Deficiency; Warfarin

Although left ventricular thrombi that form acutely after myocardial infarction frequently resolve spontaneously or with anticoagulant therapy, the fate of left ventricular thrombi in patients with remote myocardial infarction or with idiopathic cardiomyopathy remains unknown. To determine the natural history of such chronic left ventricular thrombi, we performed serial echocardiograms on 51 patients with remote myocardial infarction (greater than or equal to 3 months; mean, 31 +/- 41 months) and on nine patients with idiopathic dilated cardiomyopathy. Mean follow-up was 24 +/- 22 months during which 3.5 +/- 1.4 echocardiograms were obtained. Studies were interpreted by blinded observers, and an increase or decrease of more than 5 mm in maximal thrombus thickness was defined as significant. Among all 60 patients left ventricular thrombi were unchanged in 24 (40%), completely resolved in 24 (40%), decreased in size in four (7%), increased in size in five (8%), and decreased and then increased in size in three (5%). Results in patients with remote infarction and idiopathic cardiomyopathy were similar. Warfarin therapy, which was at the discretion of the primary physician, was associated with a higher prevalence of thrombus resolution compared with no therapy (59% vs. 29%, p = 0.02). Definite systemic emboli occurred in seven patients (12%), all at times while they were not anticoagulated. Among the 48 thrombi that were present on two or more echocardiograms, changes in thrombus shape (classified as protruding or flat) occurred in only 16%, and changes in thrombus movement (classified as mobile or immobile) occurred in only 10%.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Cardiomyopathies; Coronary Disease; Coronary Thrombosis; Echocardiography; Female; Humans; Male; Middle Aged; Myocardial Infarction; Prospective Studies; Remission, Spontaneous; Warfarin