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[Intraventricular thrombi in acute myocardial infarct. The Iberian Multicenter Study. Presentation of the study
1Faculdade de Medicina de Lisboa.
Insights
Left ventricular thrombus occurs in 22.3% of acute myocardial infarction patients, with anterior infarctions posing a higher risk. While left ventricular thrombus is linked to systemic embolism, its incidence remains low.
Area of Science:
- Cardiology
- Medical Imaging
- Thrombosis Research
Background:
- Acute myocardial infarction (AMI) can lead to complications such as left intraventricular thrombosis (LIVT) and systemic embolism (SE).
- Understanding the incidence and risk factors of LIVT and SE is crucial for patient management post-AMI.
Purpose of the Study:
- To evaluate the incidence of LIVT and SE following AMI.
- To identify risk factors associated with LIVT and SE.
- To analyze the morphologic characteristics of LIVT and their relationship with SE.
Main Methods:
- A prospective study of 1505 consecutive patients with AMI from six Iberian hospitals.
- Clinical evaluation and M-mode/2D echocardiography performed at multiple time points during a 24-month follow-up.
- Analysis focused on patients with Asinger grades III and IV for thrombus evaluation.
Main Results:
- Echocardiography quality data was available for 1360 patients; 305 (22.3%) had LIVT.
- Anterior infarctions showed a higher incidence of LIVT (39.9%) compared to other locations (11.2%).
- Systemic embolism occurred in 3.96% of patients, with a higher incidence in the first month post-AMI. LIVT, pediculated thrombus shape, large thrombus size, and older patient age correlated with SE.
Conclusions:
- A significant incidence of LIVT is observed after AMI, yet the rate of SE remains relatively low.
- Specific factors, including anterior infarction location, left ventricular failure, ventricular aneurysm, and lack of thrombolytic therapy, are associated with LIVT.
- Morphological features of LIVT and patient characteristics are identified as risk factors for systemic embolism.
Objective:
To evaluate the incidence of left intraventricular thrombosis and systemic embolism after acute myocardial infarction, as well as to determine the risk factors of each one of them. To study the morphologic aspects of the thrombus and its relation with systemic embolism. CONCEPTION AND POPULATION: 1505 consecutive patients with acute myocardial infarction from six Iberian Hospital Coronary Care Units--five from Spain and one from Portugal--were studied. All protocols included a clinical evaluation and a M-mode and 2D echocardiographic study at days 1, 3, 7 at hospital discharge, as well as at months 1, 3, 6, 12, and 24 of the follow-up. In the intraventricular thrombus evaluation just the III and IV Asinger grades were considered.
Results:
From the total studied patients an echocardiographic study of good quality for thrombus evaluation was found in 1360, and 305 (22.3%) of these had a left ventricular thrombus. In anterior infarctions the incidence of thrombus was 39.9%, and in the other localizations was 11.2%. In what concerns the thrombus morphologic aspects, we found a small thrombus (less than 4 cm2) in 71% of the cases, and a big one (greater than or equal to 4 cm2) in 29%; the shape was laminar in 53.6%, protuberant in 41.7% and pediculated in 4.6%; the outline was smooth in 56.7% and irregular in 43.3%; the echodensity was considered homogeneous in 60.1% heterogeneous in 37.6% and cavitated in 3.3%. Of the several parameters evaluated the following were correlated with left intraventricular thrombosis: anterior localization of the infarction, left ventricular failure, ventricular aneurysm, post infarction angina, bundle branche block and no thrombolytic therapy. The incidence of systemic embolism in a mean follow-up of 290 days was 3.96%, being maximum in the first month (3.4%), but an embolic episode still occurred in the following months in 3.02% of the cases. Systemic embolism correlated with left ventricular thrombus, the pediculated shape and the big size of it, as well as with the oldest patients.
Conclusions:
A high incidence of left intraventricular thrombosis after acute myocardial infarction correspond to a low incidence of systemic embolism. Some parameters correlated with intraventricular thrombus or with embolism, what allowed us to consider them as risk factors of these clinical entities.