Predictors of left ventricular thrombus formation and disappearance after anterior wall myocardial infarction
A N Nesković1, J Marinković, M Bojić
1Cardiovascular Research Center, Dedinje Cardiovascular Institute, Belgrade University Medical School, Yugoslavia.
Insights
Predictors of left ventricular thrombus after anterior myocardial infarction include high end-systolic volume and peak creatine kinase levels. Thrombus resolution is more likely in patients without apical dyskinesis.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Medical Imaging
Background:
- Acute anterior wall myocardial infarction (MI) can lead to left ventricular thrombus (LVT) formation.
- Predicting LVT formation and resolution is crucial for patient management and outcomes.
Purpose of the Study:
- To identify predictors of LVT formation after acute anterior MI.
- To determine factors influencing LVT resolution during one-year follow-up.
Main Methods:
- Analysis of clinical, echocardiographic, and angiographic data from 53 patients with anterior MI.
- Serial echocardiographic examinations over 12 months.
- Cox proportional regression modeling to identify independent predictors.
Main Results:
- LVT was detected in 56.6% of patients, primarily within the first week.
- Independent predictors of LVT formation were high end-systolic volume index and high peak creatine kinase levels.
- Thrombus resolved in 36.7% of patients; absence of apical dyskinesis at 6 weeks predicted resolution.
Conclusions:
- High initial end-systolic volume is the strongest predictor of LVT formation post-anterior MI.
- Absence of apical dyskinesis during the infarction healing phase is associated with higher likelihood of thrombus resolution.
Aims:
This study sought to determine predictors of left ventricular thrombus formation and resolution after acute anterior wall myocardial infarction.
Methods And Results:
We have analysed clinical, echocardiographic and angiographic data in 53 consecutive patients with anterior myocardial infarction. Two-dimensional and Doppler echocardiographic examinations were performed on days 1, 2, 3 and 7, after 3 and 6 weeks, and 3, 6, and 12 months following infarction. Coronary angiography was performed in 44 patients before hospital discharge. Left ventricular thrombus was detected in 30/53 patients (29/30 in the first week after infarction). Univariate analysis showed that left ventricular thrombus formation was associated with a higher initial end-systolic volume index (beta = 0.04, P = 0.001), and end-diastolic volume index (beta = 0.03, P = 0.03), a larger infarct perimeter (beta = 0.02, P = 0.01), a lower initial ejection fraction (beta = 0.06, P =0.001), a higher initial wall motion score index (beta = 1.75, P = 0.023), a higher peak creatine kinase level (beta = 3.90, P = 0.01), Killip class >1 (beta = 1.11, P = 0.003), infarct expansion (beta = 0.78, P = 0.04), occluded infarct-related artery (beta = -0.87, P = 0.04) and non-thrombolytic therapy (beta = -0.76, P = 0.047). According to the Cox proportional regression model, independent predictors of thrombus formation after anterior myocardial infarction were high end-systolic volume index (beta = 0.06, P = 0.001) and high peak creatine kinase level (beta = 5.17, P = 0.046). Thrombus disappeared in 11/30 (36.7%) patients during one-year echocardiographic follow-up. The only independent predictor of thrombus disappearance after acute myocardial infarction was the absence of apical dyskinesis 6 weeks after infarction (beta = -1.53, P = 0.045).
Conclusions:
Our data demonstrate that the best predictor of left ventricular thrombus formation after acute anterior myocardial infarction is a high initial end-systolic volume. Thrombus resolution is more likely to occur in patients without apical dyskinesis at the end of the healing phase of infarction.
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