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Association between the E-wave propagation index and left ventricular thrombus formation after ST-elevation

Lisa Steen Duus1, Sune Pedersen1, Kirstine Ravnkilde1

  • 1Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark.

International Journal of Cardiology
|November 5, 2020
PubMed

Insights

The E-wave propagation index (EPI) is strongly associated with left ventricular thrombus (LVT) formation in ST-elevation myocardial infarction (STEMI) patients. Low EPI values significantly increase the likelihood of LVT development after STEMI.

Area of Science:

  • Cardiology
  • Echocardiography
  • Cardiovascular Imaging

Background:

  • Left ventricular thrombus (LVT) formation is a significant complication in ST-elevation myocardial infarction (STEMI) patients.
  • Apical washout, assessed by the E-wave propagation index (EPI), may indicate altered left ventricular (LV) function.
  • Identifying reliable markers for LVT risk stratification is crucial for patient management.

Purpose of the Study:

  • To investigate the association between the E-wave propagation index (EPI) and the risk of left ventricular thrombus (LVT) formation.
  • To evaluate EPI as a potential echocardiographic marker for predicting LVT in STEMI patients.

Main Methods:

  • A post-hoc analysis of 364 STEMI patients who underwent echocardiography post-percutaneous coronary intervention (PCI).
  • EPI was assessed as a marker of apical washout.
  • Logistic regression models (univariable and multivariable) were used to determine the association between EPI and LVT formation.
  • Area under the receiver operating characteristic curve (AUC) was calculated to assess diagnostic performance.

Main Results:

  • 31 (8.5%) patients developed LVT.
  • EPI was significantly associated with LVT formation in both univariable (OR=1.87) and multivariable (OR=1.79) analyses.
  • Low EPI values (<1.0) were associated with a 23-fold increased likelihood of LVT formation (OR=23.41).
  • EPI demonstrated strong diagnostic ability with an AUC of 0.90.

Conclusions:

  • The E-wave propagation index (EPI) is a strong independent predictor of left ventricular thrombus (LVT) formation in STEMI patients.
  • Low EPI values indicate a markedly increased probability of LVT development, suggesting its utility in risk stratification.
  • Echocardiographic assessment of apical washout using EPI may aid in identifying STEMI patients at higher risk for LVT.
Abstract

Keywords:
E-wave propagation indexEchocardiographyLeft ventricular thrombusST-elevation myocardial infarction

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