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[The role of compromised regional function of the left ventricle in the evolution of postinfarct ventricular
M Penco1, S Romano, M T Mallus
1Dipartimento di Medicina Interna, Università degli Studi Tor Vergata, Roma.
Insights
Left ventricular thrombus (LVT) occurs in 13.8% of acute myocardial infarction (AMI) patients, associated with significant left ventricular dysfunction. Early detection and treatment are crucial for managing LVT and improving patient outcomes.
Area of Science:
- Cardiology
- Echocardiography
- Internal Medicine
Context:
- Acute myocardial infarction (AMI) is a leading cause of cardiovascular mortality.
- Left ventricular thrombus (LVT) is a potential complication of AMI, increasing embolic risk.
- Echocardiography is a key diagnostic tool for identifying LVT.
Purpose:
- To investigate the incidence, characteristics, and predictors of left ventricular thrombus (LVT) in patients with acute myocardial infarction (AMI).
- To assess the association between LVT and left ventricular dysfunction.
- To evaluate the impact of LVT on patient outcomes and the potential role of therapeutic interventions.
Summary:
- Two-dimensional echocardiography identified left ventricular thrombus (LVT) in 71 of 529 (13.8%) patients with acute myocardial infarction (AMI), predominantly in those with anterior AMI.
- Patients with LVT exhibited more extensive left ventricular dysfunction at admission, indicated by higher Killip classification, peak creatinphosphokinase levels, and echo-scores, compared to those without LVT.
- Serial echocardiograms revealed LVT disappearance in 24 patients, who showed improved regional wall motion abnormalities (lower pre-discharge echo-scores) compared to those with persistent LVT.
Impact:
- These findings underscore the importance of myocardial infarction extent and left ventricular dysfunction in LVT development and evolution.
- The results highlight the significance of treatments aimed at limiting infarct size and improving left ventricular function, such as thrombolytic therapy.
- Anticoagulant therapy may be reserved for high-risk patients with specific LVT morphologies, like protruding shapes, to mitigate embolic risk.
Abstract:
Five hundred twenty-nine patients with acute myocardial infarction (AMI) underwent clinical, enzymatic and echocardiographic evaluation. Two-dimensional echocardiography identified 71 patients with left ventricular thrombus (LVT): 63 males and 8 females; mean age 54 +/- 12 years; 70 with anterior AMI and 1 with inferior AMI. The incidence of LVT was 13.8% and 27.7% among anterior AMI. At admission to Coronary Care Unit the patients with LVT showed more extensive left ventricular dysfunction than patients without LVT: Killip classification > or = 2 was 54.5% versus 41.4%, p < 0.05; peak of creatinphosphokinase was 1337 UI/L versus 951 UI/L, p < 0.05; echo-score was 7.2 +/- 2.8 versus 4.7 +/- 3.5, p < 0.01. Serial echocardiograms showed disappearance of LVT in 24 patients. Regarding regional wall motion abnormalities, patients with LVT disappearance showed lower pre-discharge echo-scores than patients with LVT persistence (6.7 +/- 2.2 versus 8.4 +/- 2.9; p < 0.01) although echo-scores at admission were similar in the 2 groups (7.1 +/- 1.1 versus 7.3 +/- 3.4, NS). These results suggest: the importance of extension of myocardial infarction and left ventricular dysfunction in LVT evolution; the importance of treatment limiting infarct size and improving left ventricular function, such as thrombolytic therapy. Anticoagulant therapy could be limited to patients with higher risk of embolization (as the protruding shape of LVT).