Embolic potential of left ventricular thrombus after myocardial infarction: a two-dimensional echocardiographic study of 119 patients
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Two-dimensional echocardiography can identify left ventricular thrombus features, like protruding configuration and free mobility, that predict embolism risk after myocardial infarction. This aids in deciding on oral anticoagulant therapy.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Left ventricular thrombus (LVT) is a complication of myocardial infarction (MI).
- Systemic embolism is a significant risk for patients with LVT post-MI.
Purpose of the Study:
- To evaluate the role of two-dimensional echocardiography in identifying embolic potential of LVT.
- To assess the predictive value of specific echocardiographic thrombus characteristics for embolism.
Main Methods:
- Retrospective analysis of 119 patients with LVT post-MI diagnosed by two-dimensional echocardiography.
- Correlation of thrombus morphology (protruding configuration, free mobility) with embolic events.
- Assessment of anticoagulant therapy effectiveness in a subset of patients.
Main Results:
- Protruding thrombus configuration (88%) and free mobility (58%) were significantly associated with embolism.
- Echocardiographic features demonstrated high sensitivity and specificity in predicting embolism.
- Oral anticoagulant therapy showed variable effectiveness, with recurrent emboli in some patients despite treatment.
Conclusions:
- Two-dimensional echocardiography is valuable in assessing embolic risk from LVT in MI patients.
- Echocardiographic findings can guide decisions regarding the use and management of oral anticoagulant therapy.
Abstract:
Left ventricular thrombus complicating myocardial infarction was diagnosed by two-dimensional echocardiography in 119 patients. The infarct site was anterior in 98 patients and inferior in 11. Systemic embolism occurred in 26 patients (stroke in 18, lower limb embolism in 7 and mesenteric embolism in 1). A protruding configuration of the thrombus was more common in the patients with embolism than in those without (23 [88%] of 26 versus 17 [18%] of 93) (p less than 0.01). Free mobility of the thrombus was found in 15 (58%) of 26 and 3 (3%) of 93 cases, respectively (p less than 0.01). In predicting embolism, protruding thrombus configuration had a sensitivity of 88% and a specificity of 82%, and positive and negative predictive accuracy was 57 and 96%, respectively. For free mobility of the thrombus, sensitivity was 58%, specificity 97%, positive predictive accuracy 85% and negative predictive accuracy 89%. In the 46 patients whose echocardiogram was obtained during the hospital admission for the index infarct, repeat echocardiograms were obtained during oral anticoagulant therapy. Twelve of these 46 patients had embolism and 2 of the 12 died. In seven of these patients, full dose oral anticoagulant therapy had been given before embolism occurred and in five it was started after an embolic event. The thrombus decreased in size or disappeared in six patients; in four the thrombus showed no change, and in two of these four emboli recurred despite anticoagulation. It is concluded that two-dimensional echocardiography may help delineate the embolic potential of left ventricular thrombus complicating myocardial infarction and may be of value in weighing the benefits and disadvantages of oral anticoagulant therapy.