Cardiac and Extracardiac Abnormalities Detected by Cardiac Magnetic Resonance in a Post-Myocardial Infarction Cohort

Weir, Robin A.P.; Martin, Thomas N.; Petrie, Colin J.; Murphy, Aengus; Clements, Suzanne; Steedman, Tracey; Wagner, Galen S.; McMurray, John J.V.; Dargie, Henry J.

doi:10.1159/000161233

Cited by 15 publications

(13 citation statements)

References 52 publications

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“…392 STEMI (207 anterior) had paired acute and follow-up CMR Single centre Age: 58 ± 12 years Male: 82% DM: 19% Smoker: 60% MI size: 19 (10–30)% 1.5 T 7 ± 2 days and 6 months (those with LV thrombus were rescanned at 1 year (11/13) LGE imaging 574 with CMR at 1 week (LV thrombus 28–5%) 18 (5%) early LV thrombus and 9 (2%) late LV thrombus 4/18 (24%) still had LV thrombus at 6 months (anterior) 11 with LV thrombus at 6 months – 3/11 (27%) still had LV thrombus at 1 year (3/25–12%) LVEF< 50% and anterior STEMI independently predicted LV thrombus (c-statistic 0.82) Patients with anterior infarction and LVEF < 50% are at highest risk of developing LV thrombus (23/115, 20%). Gellen 2017 [ 9 ] 265 anterior STEMI Age: 58 ± 12 years Male: 85% DM: 44% Smoker: 43% MI size: 31 ± 12% CMR within 21 days LGE imaging 34/265 (12.8%) with LV thrombus CMR ≤ 5 days: 13/160 CMR > 5 days: 21/105 The highest LV thrombus detection rate was in patients with CMR performed 9 to 12 days after STEMI Weir 2009 [ 15 ] 100 Acute MI (90 STEMI, 10 NSTEMI) with LVEF< 40% Age: 59 ± 12 years Male: 77% DM: 0% Smoker: 55% MI size: 33 ± 21 ml/m 2 CMR at a mean of 4.2 days (range 2–11 days) First-pass perfusion + LGE 15/100 (15%) with LV thrombus All anterior MI (15/55, 27.3%) All patients with LV thrombus were formally anticoagulated. No patients with thromboembolic events at 6 months Surder 2015 [ 16 ] Substudy of SWISS-AMI study 177 anterior STEMI with LVEF< 45% Age: 57 ± 10 years Male: 85% DM: 11% Smoker: 59% MI size: 29 ± 12% CMR at a median of 6 (4–8)days Cine + LGE imaging 11/177 (6.2%) with LV thrombus All patients with LV thrombus were anticoagulated.…”

Section: Resultsmentioning

confidence: 99%

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Incidence and predictors of left ventricular thrombus by cardiovascular magnetic resonance in acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: a meta-analysis

Bulluck

Chan

Paradies

et al. 2018

Journal of Cardiovascular Magnetic Resonance

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IntroductionThe incidence of left ventricular (LV) thrombus formation in ST-segment elevation myocardial infarction (STEMI) patients in the current era of primary percutaneous coronary intervention (PCI) is not well established. We performed a meta-analysis to assess the actual incidence and predictors of LV thrombus by cardiovascular magnetic resonance (CMR) in STEMI treated by primary PCI.MethodsWe searched MEDLINE and EMBASE databases up to February 2018. We included all studies published as a full-text article, reporting the incidence of LV thrombus by CMR within 1 month following acute STEMI in patients treated by primary PCI. A binary random-effects model was used to estimate the pooled incidence of LV thrombus. The diagnostic performance of transthoracic echocardiography (TTE) as compared with CMR was pooled to obtain the sensitivity and specificity of TTE with CMR as the gold standard. Embolic and bleeding complications of LV thrombus were also evaluated.ResultsTen studies were included in the meta-analysis. The incidence of LV thrombus by CMR in all-comer STEMI patients (n = 2072) was 6.3% with 96% of LV thrombus occurring in those with anterior STEMI (12.2% incidence). When only anterior STEMI with LVEF< 50% were considered (n = 447), the incidence of LV thrombus was 19.2%. Compared with CMR, the sensitivity of TTE to detect LV thrombus was 29% with a specificity of 98%. The sensitivity of TTE increased to 70% in those with anterior STEMI and reduced LVEF. LV thrombus resolved in 88% of cases by 3 to 6 months. After 1–2 years follow-up, the embolic complication rate was similar at 1.5% (P = 0.25) but the bleeding complication rate was significantly higher (8.8% versus 0.5%, P < 0.001) in the LV thrombus group on triple therapy when compared to the no LV thrombus group on dual antiplatelet therapy.ConclusionIn the primary PCI era, CMR detection of an LV thrombus post-STEMI remains high with incidence of nearly 20% in anterior STEMI with depressed LVEF. Patients with LV thrombus treated by triple therapy had similar embolic complications but higher bleeding complications than those with no LV thrombus treated with dual antiplatelet therapy. A 3 month follow-up CMR scan to guide anticoagulation duration might help mitigate bleeding risk.

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Section: Resultsmentioning

confidence: 99%

“…Three studies [ 15 – 17 ] included only patients with LVEF < 40–45%. One study [ 13 ] also reported the incidence of LV thrombus in those with anterior STEMI and LVEF< 50%.…”

Section: Resultsmentioning

confidence: 99%

Incidence and predictors of left ventricular thrombus by cardiovascular magnetic resonance in acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: a meta-analysis

Bulluck

Chan

Paradies

et al. 2018

Journal of Cardiovascular Magnetic Resonance

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“…A study included 100 patients with acute myocardial infarction and LVEF < 40%, and they underwent CMR before discharge (mean scanning time of 4.2 days after admission). It was observed that left ventricular thrombus was found in 15% of the patients, all of whom were diagnosed with acute anterior myocardial infarction ( 8 ). Another study of 150 patients with left ventricular systolic dysfunction (LVEF < 40%) drew a conclusion that male gender, prior myocardial infarction, presence of an apical aneurysm, and ischemic scar were associated with thrombosis ( 9 ).…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics of patients with heart failure and intracardiac thrombus

Zhai

Huang²,

Liang³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundHeart failure (HF) patients are in a hypercoagulable state that predisposes them to an intracardiac thrombus. We aim to assess the clinical features of patients with HF and intracardiac thrombus.MethodsPatients diagnosed with HF with intracardiac thrombus were enrolled in this study. Patients' demographics, clinical comorbidities, laboratory tests, and cardiac imaging parameters are recorded. Baseline characteristics are described; the relationship between intracardiac thrombus location and cardiac underlying diseases, New York Heart Association (NYHA) class, and left ventricular ejection fraction (LVEF) are analyzed; and the anticoagulation rate is summarized.ResultsA total of 1,248 patients were included in the study. Most patients were men (72.2%) with a mean age of 54 years. The left ventricle is the most frequently involved (66.8%), and the prevalence of left ventricular thrombus is more in patients complicated with coronary artery diseases, ventricular noncompaction cardiomyopathy, and dilated cardiomyopathy (86.3%, 86.4%, and 78.2%, respectively). When combined with atrial fibrillation, atrial flutter, hypertrophic cardiomyopathy, restrictive cardiomyopathy, or valvular cardiomyopathy, the intracardiac thrombus is mostly likely to occur in the left atrium. The incidence rate of left cardiac thrombosis increased with the decline of LVEF, an increase of NYHA class, and enlargement of a cardiac chamber. Overall, the anticoagulation rate was 56.8%, with warfarin still the mainstay drug (45.1%), while the prescription of non-vitamin K antagonist oral anticoagulants rose year by year. As for imaging modalities for thrombus detection and diagnosis, transthoracic echocardiography was the most widely performed (75.1%).ConclusionThis study summarizes the underlying disease constitution, thrombus location and related factors, imaging modalities, and antithrombotic profile in HF patients with intracardiac thrombus comprehensively.

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“…The slow blood flow in the cavity of the ventricular aneurysm can lead to the formation of an intracardiac thrombus. Among 100 patients with an anterior ST segment elevation myocardial infarction and LVEF <40%, 27 patients had a left ventricular thrombus, as assessed by contrast-enhanced CMR [ 115 ]. A left ventricular thrombus is asymptomatic in the majority of cases, but it is associated with a low but significant risk of systemic thromboembolism (10–15% of cases), including strokes and transient ischemic attacks [ 114 ].…”

Section: Consequences Of Postinfarct Remodellingmentioning

confidence: 99%

Postinfarct Left Ventricular Remodelling: A Prevailing Cause of Heart Failure

Galli

Lombardi

2016

Cardiology Research and Practice

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Heart failure is a chronic disease with high morbidity and mortality, which represents a growing challenge in medicine. A major risk factor for heart failure with reduced ejection fraction is a history of myocardial infarction. The expansion of a large infarct scar and subsequent regional ventricular dilatation can cause postinfarct remodelling, leading to significant enlargement of the left ventricular chamber. It has a negative prognostic value, because it precedes the clinical manifestations of heart failure. The characteristics of the infarcted myocardium predicting postinfarct remodelling can be studied with cardiac magnetic resonance and experimental imaging modalities such as diffusion tensor imaging can identify the changes in the architecture of myocardial fibers. This review discusses all the aspects related to postinfarct left ventricular remodelling: definition, pathogenesis, diagnosis, consequences, and available therapies, together with experimental interventions that show promising results against postinfarct remodelling and heart failure.

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Cardiac and Extracardiac Abnormalities Detected by Cardiac Magnetic Resonance in a Post-Myocardial Infarction Cohort

Cited by 15 publications

References 52 publications

Incidence and predictors of left ventricular thrombus by cardiovascular magnetic resonance in acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: a meta-analysis

Incidence and predictors of left ventricular thrombus by cardiovascular magnetic resonance in acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: a meta-analysis

Clinical characteristics of patients with heart failure and intracardiac thrombus

Postinfarct Left Ventricular Remodelling: A Prevailing Cause of Heart Failure

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