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Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
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Prediction of late left ventricular thrombus formation after ST-elevation myocardial infarction: A cardiovascular

Magdalena Holzknecht1, Christina Tiller1, Ivan Lechner1

  • 1University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.

International Journal of Cardiology. Heart & Vasculature
|October 6, 2025
PubMed

Insights

A new risk score can predict late left ventricular thrombus (LVT) formation after ST-elevation myocardial infarction (STEMI). This score helps identify patients who may benefit from cardiovascular magnetic resonance (CMR) imaging for LVT assessment.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Biostatistics

Background:

  • Late left ventricular thrombus (LVT) prevalence post-ST-elevation myocardial infarction (STEMI) is poorly understood.
  • Cardiovascular magnetic resonance (CMR) offers higher sensitivity for LVT detection than transthoracic echocardiography (TTE) after STEMI.
  • Routine CMR is not standard in post-STEMI care, necessitating predictive tools.

Purpose of the Study:

  • To develop a practical risk score for predicting late LVT formation after STEMI.
  • To assess the utility of CMR in identifying patients at risk for late LVT.
  • To improve diagnostic strategies for post-STEMI complications.

Main Methods:

  • A cohort of 609 STEMI patients underwent CMR at baseline and 4-month follow-up (4FU).
  • LVT presence was assessed using CMR and TTE at baseline and 4FU.
  • A clinical risk score was developed incorporating culprit vessel (left anterior descending artery) and 4FU NT-pro-BNP levels.

Main Results:

  • Late LVT was newly diagnosed in 1.6% of patients by 4FU CMR, with TTE showing a 60% false-negative rate.
  • The developed risk score demonstrated high predictive accuracy (AUC=0.89) for late LVT.
  • The risk score achieved 100% sensitivity and 77% specificity for LVT prediction at 4FU.

Conclusions:

  • The proposed risk score shows preliminary utility in predicting late LVT after STEMI.
  • The score can help identify STEMI patients who would benefit most from CMR for late LVT assessment.
  • Further validation in larger cohorts is recommended for clinical application.
Abstract

Keywords:
Left ventricular thrombusMagnetic resonance imagingRisk scoreST-elevation myocardial infarction

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