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Updated: Mar 31, 2026
Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
Left Ventricular Thrombus Formation After ST-Segment-Elevation Myocardial Infarction: Insights From a Cardiac
Janine Pöss1, Steffen Desch1, Charlotte Eitel1
1From the Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Luebeck, Medical Clinic II, Luebeck, Germany.
Insights
Left ventricular thrombus occurs in 3.5% of ST-segment-elevation myocardial infarction patients after primary percutaneous coronary intervention. This finding is linked to adverse cardiac events within one year.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Interventional Cardiology
Background:
- Limited data exists on left ventricular (LV) thrombus formation post-primary percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction (STEMI).
- Assessing LV thrombus incidence and prognostic impact is crucial for STEMI management.
Purpose of the Study:
- To determine the incidence of LV thrombi using cardiac magnetic resonance (CMR) in a multicenter STEMI cohort.
- To evaluate the prognostic significance of LV thrombi at 1-year follow-up.
Main Methods:
- A multicenter cohort of 738 STEMI patients undergoing primary PCI was enrolled.
- Cardiac magnetic resonance (CMR) was performed within one week post-infarction.
- LV thrombi were analyzed centrally and masked; major adverse cardiac events (MACE) were tracked for 1 year.
Main Results:
- LV thrombi were detected in 3.5% of the overall STEMI cohort (7.1% in anterior STEMI).
- Thrombus presence correlated with larger infarct size, reduced myocardial salvage, lower LV ejection fraction, and increased microvascular obstruction.
- LV thrombus was an independent predictor of MACE at 12 months (HR 2.73, P=0.03).
Conclusions:
- LV thrombus prevalence in STEMI patients post-primary PCI is 3.5%, as assessed by CMR.
- LV thrombus is associated with adverse myocardial characteristics, including larger infarcts and impaired function.
- LV thrombus independently predicts major adverse cardiac events within one year, highlighting its clinical importance.
Background:
Data on left ventricular (LV) thrombus formation after primary percutaneous coronary intervention for ST-segment-elevation myocardial infarction (STEMI) are scarce. The aims of this study were to assess the (1) incidence of LV thrombi using cardiac magnetic resonance in a multicenter cohort of STEMI patients and (2) prognostic relevance of LV thrombi at 1-year follow-up.
Methods And Results:
In total, 738 STEMI patients reperfused by primary angioplasty were enrolled in 8 centers. Cardiac magnetic resonance was completed within 1 week after infarction. Central core laboratory-masked analyses for the presence of LV thrombi were performed. The primary clinical end point was the occurrence of major adverse cardiac events within 1 year. LV thrombi were detected in 26 patients (3.5%) in the overall cohort and in 7.1% in anterior STEMI patients. The presence of thrombi was associated with larger infarcts (P<0.001), less myocardial salvage (P<0.01), impaired LV ejection fraction (P<0.001), and more pronounced late microvascular obstruction (P=0.002). The presence of thrombi was independently associated with the incidence of major adverse cardiac events at 12 months (hazard ratio, 2.73; 95% confidence interval, 1.11-6.73; P=0.03).
Conclusions:
In this multicenter cohort of patients with STEMI, thrombus prevalence assessed by cardiac magnetic resonance was 3.5% and associated with decreased myocardial salvage, larger infarcts, and more pronounced reperfusion injury. Importantly, LV thrombus was independently associated with major adverse cardiac events at 1-year follow-up.
Clinical Trial Registration:
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00712101.
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