Incidence and predictors of left ventricular thrombus formation following acute ST-segment elevation myocardial infarction: A serial cardiac MRI study

Abstract

Aims Left ventricular (LV) thrombus is a complication of acute ST-segment elevation myocardial infarction (STEMI). We determined the incidence and predictors of LV thrombus formation using serial cardiac magnetic resonance (CMR) and two-dimensional echocardiography studies. Methods and results Two hundred and ten patients underwent CMR (median 4 days [IQR 3-7]) and transthoracic echocardiography (median 4 days [IQR 3-7]) early after STEMI presentation with serial follow-up CMR (median 55 days [IQR 46-64]) and echocardiography studies (median 54 days [IQR 45-64]) performed subsequently. The incidence of LV thrombus was 12.3% (26/210) by CMR and 6.2% (13/210) by two-dimensional echocardiography. Echocardiography had 50% sensitivity and 100% specificity for LV thrombus detection compared to CMR. LV thrombus was found in 23.6% of patients with anterior STEMI (22/93). Ischaemic stroke occurred in 1.4% of patients (3/210). Patients with LV thrombus had lower baseline LV ejection fraction (LVEF) (34.9% vs 47.4%, p < 0.001). Microvascular obstruction was more common in patients with LV thrombus (77% vs 39%, p < 0.001). Patients with LV thrombus had increased LV dimensions with larger LV end-diastolic (19 ml [IQR 9-44] vs 6 ml [IQR -4-18], p < 0.001) and end-systolic volumes (10 ml [IQR 0–22] vs -4 ml [IQR -12-4], p < 0.001). Conclusion CMR increases the detection of LV thrombi which standard echocardiography may underestimate. Serial studies post-STEMI may improve detection of LV thrombus, which is more prevalent in patients with anterior infarction, moderate LV dysfunction and adverse LV remodelling. This subgroup of patients may represent a high-risk group for targeted serial screening with CMR.

Association Between C-Reactive Protein to Albumin Ratio and Left Ventricular Thrombus Formation Following Acute Anterior Myocardial Infarction

“…Accordingly, a newly published cardiac magnetic resonance study found LVT in 23.6% of patients with anterior STEMI. 25 In our study, LVT was observed as 13.2% at 6 months follow-up. In agreement with previous studies, 1,24,26 patients with LVT were more likely to have lower LVEF, LVA, and had a higher incidence of the use of GPIIb/IIIa inhibitors.…”

Value of the platelet-to-lymphocyte ratio in the prediction of left ventricular thrombus in anterior ST-elevation myocardial infarction with left ventricular dysfunction

“…Recently, a prospective multicenter study showed that the incidence of LVT among patients with LV dysfunction after anterior myocardial infarction was up to 26% [ 5 ]. Moreover, detection by standard echocardiography may underestimate the incidence, especially in such a high-risk group [ 6 , 7 ]. The existing biomarkers, however, are not sufficient to predict which of the patients with anterior STEMI is prone to develop LVT, and the identification of additional early predictors would, therefore, be of benefit.…”

Peripheral Embolization of Left Ventricular Thrombus Leading to Acute Bilateral Critical Limb Ischemia: A Rare Phenomenon

“…The management of LVT and associated embolization has been actively debated due to lack of randomized clinical control trials [8,10]. A cross-sectional study evaluating 35 patients with LV apical thrombi determined that the LVT resolved in all patients being treated with aspirin and warfarin.…”