{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T11:18:54Z","timestamp":1769080734118,"version":"3.49.0"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"vor","delay-in-days":463,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2024,7,9]],"date-time":"2024-07-09T00:00:00Z","timestamp":1720483200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>We aim to assess the risk of thrombus-associated events (TAE) in patients with heart failure (HF) without atrial fibrillation (AF) and develop an effective scoring system for a risk stratification model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>This retrospective study included 450 patients (median age 64.0 years, interquartile range [55.0, 75.0]; 31.6% women) hospitalized for HF without AF and atrial flutter, but with a left ventricular ejection fraction (LVEF) \u2264 55% and New York Heart Association (NYHA) functional class of III\u2013IV. A median follow-up of 47 months was conducted. In the present study, TAE during follow-up was independently associated with both all-cause death [hazard ratio (HR) 1.756, 95% confidence interval (CI) 1.324\u20132.328, P &amp;lt; 0.001] and readmission for HF (HR 1.574, 95% CI 1.122\u20132.208, P = 0.009) after adjustment for covariates. Hypertension (HR 1.573, 95% CI 1.018\u20132.429, P = 0.041), atrial arrhythmia excluding AF (AAexAF) (HR 2.041, 95% CI 1.066\u20133.908, P = 0.031), previous ischaemic stroke (HR 2.469, 95% CI 1.576\u20133.869, P &amp;lt; 0.001), and vascular disease (HR 1.658, 95% CI 1.074\u20132.562, P = 0.023) were independently associated with TAE. Age (HR 1.021, 95% CI 1.008\u20131.033, P = 0.001), previous ischaemic stroke (HR 1.685, 95% CI 1.248\u20132.274, P = 0.001), LVEF ([10, 25] vs. [40, 55]) HR 1.925, 95% CI 1.311\u20132.826, P = 0.001; (25, 40] vs. (40, 55] HR 1.084, 95% CI 0.825\u20131.424, P = 0.563), and creatinine clearance rate (Ccr) (HR 0.991, 95% CI 0.986\u20130.996, P = 0.001) were independently associated with composite events of TAE and death (TAE-D). CHA2DS2VASc modestly predicted 5-year TAE [area under the receiver operating characteristic curves (AUC) 0.660, P &amp;lt; 0.001 compared with 0.5] and TAE-D (AUC 0.639, P &amp;lt; 0.001 compared with 0.5). (C)ACE, formed by incorporating AAexAF, LVEF, and Ccr into CHA2DS2VASc, had higher AUC for predicting 5-year TAE (0.694 vs. 0.660, P = 0.018) and TAE-D (0.708 vs. 0.639, P &amp;lt; 0.001) compared with CHA2DS2VASc. In patients with HF with reduced ejection fraction (HFrEF), (C)ACE and (C)ACEN [formed by incorporating NYHA into (C)ACE] had higher AUC compared with CHA2DS2VASc in predicting 5-year TAE (0.700 and 0.707 vs. 0.649, P = 0.013 and 0.030, respectively) and TAE-D (0.712 and 0.713 vs. 0.622, P &amp;lt; 0.001 and &amp;lt;0.001, respectively). The AUC did not improve statistically from (C)ACE to (C)ACEN (0.700 vs. 0.707, P = 0.600 for TAE; 0.712 vs. 0.713, P = 0.917 for TAE-D).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In HF without AF, TAE during follow-up was associated with adverse prognoses. The independent risk factors of TAE or TAE-D improved CHA2DS2-VASc predictive ability, especially in patients with HFrEF. Our findings provide new evidence for TAE risk stratification in HF without AF, potentially guiding prophylactic anticoagulation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.14952","type":"journal-article","created":{"date-parts":[[2024,7,9]],"date-time":"2024-07-09T07:55:04Z","timestamp":1720511704000},"page":"3687-3701","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognoses and Risk Stratification of Thrombus-Associated Events in Heart Failure Patients Without Atrial Fibrillation"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2377-9503","authenticated-orcid":false,"given":"Yanxuan","family":"Li","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, China-Japan Union Hospital of Jilin University , Changchun ,","place":["China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zihan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, China-Japan Union Hospital of Jilin University , Changchun ,","place":["China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daoyuan","family":"Si","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, China-Japan Union Hospital of Jilin University , Changchun ,","place":["China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ping","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, China-Japan Union Hospital of Jilin University , Changchun ,","place":["China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,7,9]]},"reference":[{"key":"2026012113115040500_ehf214952-bib-0001","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1002\/ehf2.13091","article-title":"Risk of stroke in patients with heart failure and sinus rhythm: Data from the Swedish Heart Failure Registry","volume":"8","author":"Hjalmarsson","year":"2021","journal-title":"ESC Heart Fail"},{"key":"2026012113115040500_ehf214952-bib-0002","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1002\/jcu.21953","article-title":"Prevalence of left chamber cardiac thrombi in patients with dilated left ventricle at sinus rhythm: The role of transesophageal echocardiography","volume":"41","author":"Bakalli","year":"2013","journal-title":"J Clin Ultrasound"},{"key":"2026012113115040500_ehf214952-bib-0003","doi-asserted-by":"publisher","first-page":"e30","DOI":"10.1016\/s2352-3026(15)00228-8","article-title":"Heart failure and risk of venous thromboembolism: A systematic review and meta-analysis","volume":"3","author":"Tang","year":"2016","journal-title":"Lancet Haematol"},{"key":"2026012113115040500_ehf214952-bib-0004","doi-asserted-by":"publisher","DOI":"10.1161\/jaha.119.014907","article-title":"Association between subsequent hospitalizations and recurrent acute myocardial infarction within 1 year after acute myocardial infarction","volume":"9","author":"Wang","year":"2020","journal-title":"J Am Heart Assoc"},{"key":"2026012113115040500_ehf214952-bib-0005","doi-asserted-by":"publisher","DOI":"10.1161\/jaha.121.022525","article-title":"Ischemic stroke in acute decompensated heart failure: From the KCHF registry","volume":"10","author":"Iguchi","year":"2021","journal-title":"J Am Heart Assoc"},{"key":"2026012113115040500_ehf214952-bib-0006","doi-asserted-by":"publisher","DOI":"10.1111\/ijcp.14558","article-title":"The significance of heart failure in hospitalised patients with pulmonary embolism. 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