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Prospective two-dimensional echocardiographic evaluation of left ventricular thrombus and embolism after acute
1Department of Medicine, University of Alberta, Edmonton, Canada.
Insights
Two-dimensional echocardiography can identify patients with left ventricular thrombus after myocardial infarction prone to embolism. Thrombus mobility and adjacent hyperkinesia are key indicators, not size or location, guiding anticoagulant therapy duration.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Left ventricular thrombus formation is a known complication after myocardial infarction.
- Identifying patients at high risk for embolism is crucial for effective management.
Purpose of the Study:
- To evaluate if two-dimensional echocardiography can predict embolism risk in patients with left ventricular thrombus post-myocardial infarction.
- To identify echocardiographic features associated with embolic events.
Main Methods:
- Prospective study of 541 patients with first myocardial infarction.
- Echocardiography used to detect left ventricular thrombus and assess its characteristics.
- Clinical data collected to identify systemic embolism events.
Main Results:
- Echocardiography detected left ventricular thrombus in 21% of patients.
- Thrombus size, location, and apical protrusion did not correlate with embolism.
- Thrombus mobility, adjacent hyperkinesia, and protrusion in multiple views were significant predictors of embolism.
Conclusions:
- Echocardiographic assessment of thrombus mobility and adjacent hyperkinesia can identify patients with left ventricular thrombus at higher risk of embolism.
- These findings may guide the duration of anticoagulant therapy in post-myocardial infarction patients.
Abstract:
To determine whether two-dimensional echocardiography can identify patients with left ventricular thrombus after myocardial infarction who are prone to embolism, clinical and echocardiographic variables in 541 patients with a first infarction between 1979 and 1983 were studied prospectively. The first echocardiogram showed definite thrombus in 115 patients (Group 1, 21%) and no thrombus in 426 (Group 2, control). In Group 1, 27 patients (23%) had clinical evidence of systemic embolism related to the thrombus before referral (Group 1a) and 88 did not (Group 1b); these two groups were similar in age, gender and infarct location, but more Group 1a patients were within 1 month of the acute infarction. In both Groups 1a and 1b, the thrombus was found in apical views over asynergic zones, with no difference (p greater than 0.05) between the two groups in the size (average area from two views being 5.3 versus 4.5 cm2), type (protruding in apical views 30% versus 27%), location (apical 83% versus 86%; septal 11% versus 11%; posterior 4% versus 2%), extent of asynergy (31% versus 33%) and ejection fraction (33% versus 34%). However, the frequency of anticoagulant therapy was less (26% versus 63%, p less than 0.005), adjacent hyperkinesia greater (100% versus 49%, p less than 0.005) and thrombus mobility greater (81% versus 19%, p less than 0.005) in Group 1a than in Group 1b. Serial echocardiograms revealed a decreased size of the thrombus by 6 months in both Groups 1a and 1b, and little or no trace in 85% by 24 months. Thus, ventricular thrombus size, location and protrusion in apical views on echocardiography did not correlate with embolism. In contrast, thrombus mobility, the presence of adjacent hyperkinesia and thrombus protrusion assessed in multiple views appeared to be strong discriminators of thrombus prone to embolism. These echocardiographic features might provide a guide for the duration of anticoagulant therapy.