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Doppler left ventricular flow pattern versus conventional predictors of left ventricular thrombus after acute
J M Van Dantzig1, B J Delemarre, H Bot
1Academic Medical Center, Department of Cardiology, Amsterdam, The Netherlands.
Insights
Doppler-derived left ventricular spatial flow patterns accurately predict left ventricular thrombus after myocardial infarction. This method is superior to conventional assessments for estimating thrombosis risk.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Left ventricular thrombosis after myocardial infarction poses embolic risks.
- Oral anticoagulants reduce embolic sequelae.
Purpose of the Study:
- To compare Doppler-derived left ventricular spatial flow patterns with conventional methods for predicting left ventricular thrombus formation post-myocardial infarction.
Main Methods:
- Prospective study of 104 acute myocardial infarction patients.
- Assessed ventricular flow using Doppler echocardiography, identifying normal, apical rotating, and vortex ring patterns.
- Prescribed anticoagulants based on admission flow patterns.
Main Results:
- Abnormal flow patterns showed a 63% positive predictive value and 99% negative predictive value for left ventricular thrombus.
- Abnormal flow pattern was independently related to left ventricular thrombus (OR 92).
Conclusions:
- Doppler-derived left ventricular flow patterns are superior to conventional assessments in predicting left ventricular thrombosis risk after myocardial infarction.
Objectives:
The value of Doppler-derived left ventricular spatial flow patterns in predicting left ventricular thrombus formation after myocardial infarction was compared with that of conventional clinical and echocardiographic variables.
Background:
Assessment of left ventricular thrombosis risk after myocardial infarction is important because of potential embolic sequelae that are reduced by oral anticoagulant agents.
Methods:
Clinical, two-dimensional and Doppler echocardiographic data were prospectively obtained in 104 patients with acute myocardial infarction within 48 h of admission. Ventricular flow was assessed by Doppler echocardiography and considered normal when brisk ventricular inflow with simultaneous onset at the mitral valve and apical levels was present, together with alternating directions of apical flow throughout the cardiac cycle. In addition to normal flow, two abnormal flow patterns were recognized: apical rotating flow and vortex ring formation. Oral anticoagulant agents were prescribed only to patients with abnormal flow at admission. The incidence of left ventricular thrombosis was assessed by echocardiography during 9 months of follow-up.
Results:
Abnormal flow pattern had a positive predictive value of 63% and a negative predictive value of 99%. On stepwise logistic regression analysis, only abnormal flow pattern had an independent relation to left ventricular thrombus (odds ratio 92).
Conclusions:
Left ventricular flow pattern derived by Doppler echocardiography soon after admission is superior to conventional clinical and two-dimensional echocardiographic assessment in estimating the risk of left ventricular thrombosis after myocardial infarction.