Predictors and prognosis of left ventricular thrombus in post-myocardial infarction patients with left ventricular
Jieyun You1, Xingxu Wang1, Jian Wu2
1Department of Cardiovascular Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China.
Insights
Left ventricular thrombus (LVT) in post-myocardial infarction (MI) patients is predicted by left ventricular aneurysm, incomplete revascularization, SYNTAX score, and D-dimer. LVT presence is linked to worse clinical outcomes, including stroke.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomarkers
Background:
- Left ventricular thrombus (LVT) is a complication in patients with left ventricular dysfunction post-myocardial infarction (MI).
- Contemporary percutaneous coronary intervention (PCI) aims to improve outcomes, but LVT risk factors and prognosis require further investigation.
Purpose of the Study:
- To identify predictors of LVT formation in post-MI patients with left ventricular dysfunction.
- To evaluate the prognostic significance of LVT on clinical outcomes after PCI.
Main Methods:
- Prospective enrollment of 267 post-MI patients with LVEF <0.45 undergoing PCI.
- Comparison of baseline, angiographic, and procedural characteristics between patients with and without LVT.
- 1-year clinical outcomes assessed using survival analysis; logistic regression used for LVT prediction.
Main Results:
- Independent predictors of LVT included left ventricular aneurysm, incomplete revascularization, higher SYNTAX score, and elevated D-dimer levels.
- Optimal cutoff values for SYNTAX score (29.50) and D-dimer (1.53 mg/L) predicted LVT development.
- LVT patients experienced significantly worse 1-year outcomes, notably a higher incidence of stroke.
Conclusions:
- Left ventricular aneurysm, incomplete revascularization, high SYNTAX score, and D-dimer are key predictors of LVT in this patient cohort.
- LVT is associated with adverse clinical outcomes, emphasizing the need for risk stratification.
- Future research should focus on early intervention and complete revascularization in high-risk patients to mitigate LVT risk.
Background:
We aimed to investigate the predictors and prognosis of left ventricular thrombus (LVT) in patients admitted for post-myocardial infarction (MI) and left ventricular dysfunction after contemporary percutaneous coronary intervention (PCI).
Methods:
We prospectively enrolled 267 consecutive post-MI patients with left ventricular ejection fraction (LVEF) <0.45 based on the Shanghai East Hospital PCI database since 2012. Altogether 25 (9.36%) patients were selected as the LVT group. Baseline, angiographic, procedural characteristics and 1-year clinical outcomes were compared by Chi-square test, t-test or Kaplan-Meier survival analysis as appropriate. Receiver operating characteristic (ROC) curves were plotted for the accuracy of the multivariate analysis model. A multiple logistic regression was applied to predict LVT formation.
Results:
The independent risk factors of LVT were left ventricular aneurysm [odds ratio (OR): 1.29, 95% confidence interval (CI): 1.09-1.52, P<0.01], incomplete revascularization (OR: 0.05, 95% CI: 0.01-0.35, P<0.01), SYNTAX score (OR: 1.28, 95% CI: 1.14-1.43, P<0.01) and D-dimer (OR: 1.90, 95% CI: 1.19-3.04, P<0.01). The SYNTAX score and D-dimer effectively indicated the development of LVT with optimal cutoff values of 29.50 and 1.53 mg/L, respectively. Patients with LVT had significantly worse outcomes at 1-year clinical follow-up, especially higher incidence of ischemic or hemorrhagic stroke.
Conclusions:
This study indicated that the presence of left ventricular aneurysm, incomplete revascularization, higher SYNTAX score and D-dimer level were the independent predictors of LVT formation in post-MI and LV dysfunction patients, which related to worse clinical outcomes. Future studies for early intervention and complete revascularization in high-risk subgroup patients are expected.
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