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Left ventricular mural thrombus following myocardial infarction--a follow up study
M R Vidhya1, K Haranath, I Sathyamurthy
1Department of Internal Medicine, Apollo Hospitals Chennai.
Insights
Left ventricular thrombi after myocardial infarction (MI) pose embolic risks, especially with LV aneurysm. Anticoagulants effectively prevent embolism in recent MI but are less useful for chronic thrombi.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Thrombosis Research
Background:
- Left ventricular mural thrombus (LVMT) is a potential complication following myocardial infarction (MI).
- Understanding the natural history and risk factors for LVMT is crucial for patient management.
- Echocardiography is a primary tool for detecting LVMT and assessing left ventricular (LV) function.
Purpose of the Study:
- To follow up patients with LVMT after MI to assess thrombus persistence, embolic events, and outcomes.
- To identify risk factors associated with persistent LVMT and embolic complications.
- To evaluate the efficacy of anticoagulant therapy in preventing embolic events in different stages of LVMT.
Main Methods:
- Echocardiographic assessment of 41 patients with LVMT post-MI over a 4-year follow-up period.
- Evaluation of thrombus characteristics (type, mobility), regional wall motion abnormality (RWMA), and LV aneurysm.
- Monitoring for embolic events, mortality, and thrombus resolution (spontaneous or treatment-induced).
Main Results:
- Predominantly mural, non-mobile LVMT was observed, often associated with RWMA and LV aneurysm (28/41 patients).
- Six patients experienced embolic events, including one fatal embolic stroke.
- Anticoagulant therapy was effective in preventing embolism in recent MI (<3 weeks) but not in chronic LVMT. Persistent thrombi were linked to severe LV dysfunction and LV aneurysm.
Conclusions:
- LVMT after MI carries a significant risk of embolism, particularly in the presence of LV aneurysm and severe LV dysfunction.
- Anticoagulant therapy demonstrates efficacy in acute settings but its role in chronic LVMT requires further investigation.
- A randomized trial is warranted to determine the definitive role of anticoagulants in managing chronic LVMT with ongoing embolic risk.
Abstract:
Left Ventricular mural thrombus detected by echocardiography in 41 patients after myocardial infarction (MI) were followed up for 4 years. Thirty eight patients were males and mean age of study population was 52.4 years. Echocardiography revealed predominant mural type of thrombi (38 patients) and none showed mobility. All of them showed regional wall motion abnormality (RWMA) and Left Ventricular (LV) aneurysm was found in 28 patients. Embolic events were observed in 6 patients and 1 patient died following embolic stroke. Follow up study revealed persistent left ventricular thrombus in 19 patients and risk factors detected were severe LV dysfunction and LV aneurysm. Six patients had spontaneous resolution and 6 had resolution of the thrombus after anticoagulants. While anticoagulant therapy was very effective in preventing embolism after recent MI (within 3 weeks), it was found not useful in chronic LV thrombi. We observed ongoing embolic risk in chronic LV thrombi with LV aneurysms but a randomised trial is needed to decide the role of anticoagulants in such situation.