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

E-wave propagation index (EPI) could be a simple echocardiographic parameter to identify patients at increased risk of left ventricular (LV) thrombus following ST-elevation myocardial infarction (STEMI). We aimed to investigate the association between EPI and LV thrombus as assessed by cardiac magnetic resonance imaging (MRI).

We included 665 STEMI patients treated with percutaneous coronary intervention from the MARINA-STEMI study. EPI was measured using transthoracic echocardiography at 3 (IQR 2-4) days post-STEMI and calculated as the ratio of the E-wave velocity-time integral to the LV end-diastolic length, measured in the apical four-chamber view. LV thrombus was evaluated with cardiac MRI at 4 (IQR 3-5) days post-STEMI. A total of 665 STEMI patients (17% female) with a median age of 58 [IQR 52-66] years were included. Patients with LV thrombus (n = 32, 5%) had a significantly lower EPI than those without (0.92 vs. 1.29, P < 0.001). EPI independently predicted LV thrombus with an adjusted odds ratio of 0.84 (95% CI 0.74-0.95; P = 0.007). The area under the curve for EPI in detecting LV thrombus was 0.73 (95% CI 0.64-0.82, P < 0.001). EPI of 0.95 emerged as best cut-off to identify patients at high risk of LV thrombus formation (15.9% thrombus rate in patients with EPI < 0.95 as compared to 2.5% in patients with EPI ≥ 0.95).

EPI emerged as significant and independent predictor of LV thrombus formation in STEMI patients. These findings highlight the usefulness of EPI as simple echocardiographic parameter to optimize LV thrombus screening in routine STEMI care.