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%CI 1.01-1.12, 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.
目的： 探讨非缺血性心力衰竭患者合并左心室血栓的影响因素，构建非缺血性心力衰竭患者合并左心室血栓的诺莫图筛查模型。 方法： 本研究为病例对照研究。选取2018年1月至2022年7月于首都医科大学附属北京安贞医院住院的2 592例非缺血性心力衰竭患者，通过超声心动图和心脏磁共振筛选出51例合并左心室血栓的患者作为左心室血栓组，再根据年龄、性别进行1∶3倾向性评分匹配，选取160例患者作为无左心室血栓组。采用多因素logistic回归分析探讨非缺血性心力衰竭患者合并左心室血栓的影响因素。构建诺莫图预测模型，并计算受试者工作特征曲线下面积，评估该模型的预测效果。 结果： 最终共纳入患者211例，中位年龄40岁，男性160例（76%）。与无左心室血栓组相比，左心室血栓组患者收缩压［（112±20）mmHg比（120±19）mmHg；1 mmHg=0.133 kPa］和左心室射血分数（LVEF）［（27±12）% 比（39±14）%］较低、有高血压病史［28%（14/51）比44%（70/160）］和心房颤动病史［8%（4/51）比39%（62/160）］的患者比例较低，纽约心脏协会心功能分级Ⅲ~Ⅳ的患者比例较高［Ⅲ级：59%（30/51）比41%（66/160）；Ⅳ级：28%（14/51）比19%（31/160）］，左心室收缩末期内径（LVESD）［（56±14）mm 比（50±15）mm］较大，血红蛋白［（152±23）g/L比（142±30）g/L］、D-二聚体［508（300，1 105）μg/L比158（68，379）μg/L］和N末端B型利钠肽原［3 429（2 462，4 734）ng/L 比1 288（422，2 544）ng/L］水平较高（P均<0.05）。左心室血栓组使用β受体阻滞剂［92%（47/51）比78%（124/160）］、血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂/血管紧张素受体脑啡肽酶抑制剂［88%（45/51）比72%（115/160）］、抗凝药物［98%（50/51）比32%（51/160）］的患者比例比无左心室血栓组高（P均<0.05）。多因素logistics回归结果显示，LVEF降低（OR=1.08，95%CI 1.02~1.15，P=0.008）、LVESD减小（OR=1.07，95%CI 1.01~1.12，P=0.013）和D-二聚体升高（OR=5.40，95%CI 1.98~14.74，P=0.001）是非缺血性心力衰竭患者合并左心室血栓的独立影响因子。受试者工作特征曲线分析显示，诺莫图预测非缺血性心力衰竭患者合并左心室血栓的曲线下面积为0.793（95%CI 0.710~0.876，P<0.001）。 结论： LVEF降低、LVESD减小和D-二聚体水平升高与非缺血性心力衰竭患者合并左心室血栓相关，上述指标对非缺血性心力衰竭患者合并左心室血栓具有一定预测价值。.