Cancer-associated left ventricular thrombus in hospitalized oncology patients: National burden and inpatient outcomes.

Abstract

e23230 Background: Left ventricular thrombus is an uncommon, but high-risk cardiac finding that may reflect acute cardio-oncologic decompensation during hospitalization. Contemporary national data describing its inpatient burden and associated outcomes in hospitalized cancer populations are limited. This study evaluated the prevalence of left ventricular thrombus and its association with inpatient outcomes and resource utilization during cancer hospitalizations. Methods: A serial cross-sectional analysis was conducted using adult hospitalizations with a principal diagnosis of malignancy in the 2018 to 2023 Healthcare Cost and Utilization Project National Inpatient Sample with discharge-level survey weighting. Left ventricular thrombus was identified using ICD-10-CM code I51.3 in any diagnosis field. Outcomes included in-hospital mortality, mechanical ventilation (ICD-10-PCS 5A1935Z, 5A1945Z, 5A1955Z), shock, all types (R57*), stroke (I63 or I61), pulmonary embolism (I26*), length of stay, and hospitalization cost using cost-to-charge ratios. National estimates accounted for survey stratification and clustering. Survey-weighted multivariable regression adjusted for demographics, year, payer, ZIP-code income quartile, elective status, hospital teaching status, region, and All Patient Refined Diagnosis Related Group severity. Results: Among cancer hospitalizations, left ventricular thrombus prevalence was 0.13%, corresponding to approximately 7,620 hospitalizations nationally from 2018 to 2023. In-hospital mortality was higher among hospitalizations with left ventricular thrombus compared with those without (9.12% vs 4.36%). Left ventricular thrombus was associated with higher rates of mechanical ventilation (5.58% vs 2.57%), shock (4.72% vs 1.47%), stroke (5.77% vs 1.57%), and pulmonary embolism (14.83% vs 2.03%). Resource utilization was greater, with longer length of stay (9.73 vs 6.86 days) and higher mean hospitalization cost ($40,064 vs $30,537).After weight adjustment, left ventricular thrombus was not independently associated with in-hospital mortality (adjusted odds ratio 1.15, 95% CI 0.70 to 1.87) but remained independently associated with shock (adjusted odds ratio 2.45, 95% CI 1.32 to 4.52). Conclusions: Left ventricular thrombus is an uncommon but clinically meaningful inpatient finding among hospitalized cancer patients and is associated with increased intubation, thromboembolic complications, and resource utilization. The persistent association with shock supports left ventricular thrombus as an important prognostic marker for hospitalized cancer patients leading to significant morbidity and mortality.