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E-wave propagation index predicts left ventricular thrombus in patients after ST-elevation myocardial infarction

Priscilla Fink1, Ivan Lechner1, Christina Tiller1

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

European Heart Journal. Acute Cardiovascular Care
|January 13, 2026
PubMed

Insights

The E-wave propagation index (EPI) can predict left ventricular (LV) thrombus in ST-elevation myocardial infarction (STEMI) patients. Lower EPI values indicate a higher risk of LV thrombus formation, aiding in screening.

Area of Science:

  • Cardiology
  • Echocardiography
  • Cardiac Imaging

Background:

  • Left ventricular (LV) thrombus is a complication following ST-elevation myocardial infarction (STEMI).
  • Early identification of patients at risk for LV thrombus is crucial for effective management.
  • The E-wave propagation index (EPI) is a potential echocardiographic marker for assessing LV thrombus risk.

Purpose of the Study:

  • To investigate the association between the E-wave propagation index (EPI) and left ventricular (LV) thrombus.
  • To assess the utility of EPI in identifying STEMI patients at increased risk of LV thrombus.
  • To compare EPI with cardiac magnetic resonance imaging (MRI) for LV thrombus detection.

Main Methods:

  • A cohort of 665 STEMI patients treated with percutaneous coronary intervention was analyzed.
  • E-wave propagation index (EPI) was measured via transthoracic echocardiography 3 days post-STEMI.
  • Left ventricular (LV) thrombus was evaluated using cardiac MRI 4 days post-STEMI.

Main Results:

  • Patients with LV thrombus (5%) exhibited significantly lower EPI compared to those without (0.92 vs. 1.29, p<0.001).
  • EPI independently predicted LV thrombus with an adjusted odds ratio of 0.84 (p=0.007).
  • An EPI cutoff of 0.95 effectively identified high-risk patients, showing a 15.9% thrombus rate versus 2.5% in lower-risk patients.

Conclusions:

  • The E-wave propagation index (EPI) is a significant and independent predictor of LV thrombus formation in STEMI patients.
  • EPI serves as a valuable and simple echocardiographic tool for optimizing LV thrombus screening in routine STEMI care.
  • These findings support the integration of EPI measurement into standard STEMI patient assessment.
Abstract

Keywords:
E-wave propagation indexLeft ventricular thrombusMagnetic resonance imagingST-elevation myocardial infarction

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