Project Grant R21HL189472

The National Heart, Lung, and Blood Institute awarded the Regents of the University of Minnesota $231,000 on August 15, 2026, under the Cardiovascular Diseases Research program (CFDA 93.837) to develop and validate a risk prediction tool for thromboembolism in heart failure patients without atrial fibrillation.

The project will integrate clinical variables with cardiovascular magnetic resonance biomarkers to create the first comprehensive risk stratification score for incident ischemic stroke and extracranial embolism in heart failure patients with reduced ejection fraction and no atrial fibrillation. The research addresses the clinical gap where no validated tool currently exists to identify the 4–5 million such patients who would benefit most from anticoagulation. The project will use secondary analysis of existing multicenter CMR datasets to develop and internally validate the risk score, followed by external validation in an independent patient cohort. The work will also demonstrate that left ventricular thrombus serves as the mechanistic mediator linking risk factors to thromboembolic events through formal causal mediation analysis. The risk score will integrate clinical predictors with CMR biomarkers corresponding to Virchow's triad: systolic dysfunction, myocardial scar, and left ventricular hypertrabeculation.

Performance is at the University of Minnesota in Minneapolis, Minnesota. The period of performance runs through May 31, 2028. This award is a Project Grant, an assistance type.