Cargando…

Incidence and predictors of left ventricular thrombus formation following acute ST-segment elevation myocardial infarction: A serial cardiac MRI study()

AIMS: Left ventricular (LV) thrombus is a complication of acute ST-segment elevation myocardial infarction (STEMI). We determined the incidence and predictors of LV thrombus formation using serial cardiac magnetic resonance (CMR) and two-dimensional echocardiography studies. METHODS AND RESULTS: Two...

Descripción completa

Detalles Bibliográficos
Autores principales: Phan, Justin, Nguyen, Tuan, French, John, Moses, Daniel, Schlaphoff, Glen, Lo, Sidney, Juergens, Craig, Dimitri, Hany, Richards, David, Thomas, Liza
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612928/
https://www.ncbi.nlm.nih.gov/pubmed/31321288
http://dx.doi.org/10.1016/j.ijcha.2019.100395
_version_ 1783432965360975872
author Phan, Justin
Nguyen, Tuan
French, John
Moses, Daniel
Schlaphoff, Glen
Lo, Sidney
Juergens, Craig
Dimitri, Hany
Richards, David
Thomas, Liza
author_facet Phan, Justin
Nguyen, Tuan
French, John
Moses, Daniel
Schlaphoff, Glen
Lo, Sidney
Juergens, Craig
Dimitri, Hany
Richards, David
Thomas, Liza
author_sort Phan, Justin
collection PubMed
description AIMS: Left ventricular (LV) thrombus is a complication of acute ST-segment elevation myocardial infarction (STEMI). We determined the incidence and predictors of LV thrombus formation using serial cardiac magnetic resonance (CMR) and two-dimensional echocardiography studies. METHODS AND RESULTS: Two hundred and ten patients underwent CMR (median 4 days [IQR 3-7]) and transthoracic echocardiography (median 4 days [IQR 3-7]) early after STEMI presentation with serial follow-up CMR (median 55 days [IQR 46-64]) and echocardiography studies (median 54 days [IQR 45-64]) performed subsequently. The incidence of LV thrombus was 12.3% (26/210) by CMR and 6.2% (13/210) by two-dimensional echocardiography. Echocardiography had 50% sensitivity and 100% specificity for LV thrombus detection compared to CMR. LV thrombus was found in 23.6% of patients with anterior STEMI (22/93). Ischaemic stroke occurred in 1.4% of patients (3/210). Patients with LV thrombus had lower baseline LV ejection fraction (LVEF) (34.9% vs 47.4%, p < 0.001). Microvascular obstruction was more common in patients with LV thrombus (77% vs 39%, p < 0.001). Patients with LV thrombus had increased LV dimensions with larger LV end-diastolic (19 ml [IQR 9-44] vs 6 ml [IQR -4-18], p < 0.001) and end-systolic volumes (10 ml [IQR 0–22] vs -4 ml [IQR -12-4], p < 0.001). CONCLUSION: CMR increases the detection of LV thrombi which standard echocardiography may underestimate. Serial studies post-STEMI may improve detection of LV thrombus, which is more prevalent in patients with anterior infarction, moderate LV dysfunction and adverse LV remodelling. This subgroup of patients may represent a high-risk group for targeted serial screening with CMR.
format Online
Article
Text
id pubmed-6612928
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-66129282019-07-18 Incidence and predictors of left ventricular thrombus formation following acute ST-segment elevation myocardial infarction: A serial cardiac MRI study() Phan, Justin Nguyen, Tuan French, John Moses, Daniel Schlaphoff, Glen Lo, Sidney Juergens, Craig Dimitri, Hany Richards, David Thomas, Liza Int J Cardiol Heart Vasc Original Paper AIMS: Left ventricular (LV) thrombus is a complication of acute ST-segment elevation myocardial infarction (STEMI). We determined the incidence and predictors of LV thrombus formation using serial cardiac magnetic resonance (CMR) and two-dimensional echocardiography studies. METHODS AND RESULTS: Two hundred and ten patients underwent CMR (median 4 days [IQR 3-7]) and transthoracic echocardiography (median 4 days [IQR 3-7]) early after STEMI presentation with serial follow-up CMR (median 55 days [IQR 46-64]) and echocardiography studies (median 54 days [IQR 45-64]) performed subsequently. The incidence of LV thrombus was 12.3% (26/210) by CMR and 6.2% (13/210) by two-dimensional echocardiography. Echocardiography had 50% sensitivity and 100% specificity for LV thrombus detection compared to CMR. LV thrombus was found in 23.6% of patients with anterior STEMI (22/93). Ischaemic stroke occurred in 1.4% of patients (3/210). Patients with LV thrombus had lower baseline LV ejection fraction (LVEF) (34.9% vs 47.4%, p < 0.001). Microvascular obstruction was more common in patients with LV thrombus (77% vs 39%, p < 0.001). Patients with LV thrombus had increased LV dimensions with larger LV end-diastolic (19 ml [IQR 9-44] vs 6 ml [IQR -4-18], p < 0.001) and end-systolic volumes (10 ml [IQR 0–22] vs -4 ml [IQR -12-4], p < 0.001). CONCLUSION: CMR increases the detection of LV thrombi which standard echocardiography may underestimate. Serial studies post-STEMI may improve detection of LV thrombus, which is more prevalent in patients with anterior infarction, moderate LV dysfunction and adverse LV remodelling. This subgroup of patients may represent a high-risk group for targeted serial screening with CMR. Elsevier 2019-07-04 /pmc/articles/PMC6612928/ /pubmed/31321288 http://dx.doi.org/10.1016/j.ijcha.2019.100395 Text en © 2019 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Paper
Phan, Justin
Nguyen, Tuan
French, John
Moses, Daniel
Schlaphoff, Glen
Lo, Sidney
Juergens, Craig
Dimitri, Hany
Richards, David
Thomas, Liza
Incidence and predictors of left ventricular thrombus formation following acute ST-segment elevation myocardial infarction: A serial cardiac MRI study()
title Incidence and predictors of left ventricular thrombus formation following acute ST-segment elevation myocardial infarction: A serial cardiac MRI study()
title_full Incidence and predictors of left ventricular thrombus formation following acute ST-segment elevation myocardial infarction: A serial cardiac MRI study()
title_fullStr Incidence and predictors of left ventricular thrombus formation following acute ST-segment elevation myocardial infarction: A serial cardiac MRI study()
title_full_unstemmed Incidence and predictors of left ventricular thrombus formation following acute ST-segment elevation myocardial infarction: A serial cardiac MRI study()
title_short Incidence and predictors of left ventricular thrombus formation following acute ST-segment elevation myocardial infarction: A serial cardiac MRI study()
title_sort incidence and predictors of left ventricular thrombus formation following acute st-segment elevation myocardial infarction: a serial cardiac mri study()
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612928/
https://www.ncbi.nlm.nih.gov/pubmed/31321288
http://dx.doi.org/10.1016/j.ijcha.2019.100395
work_keys_str_mv AT phanjustin incidenceandpredictorsofleftventricularthrombusformationfollowingacutestsegmentelevationmyocardialinfarctionaserialcardiacmristudy
AT nguyentuan incidenceandpredictorsofleftventricularthrombusformationfollowingacutestsegmentelevationmyocardialinfarctionaserialcardiacmristudy
AT frenchjohn incidenceandpredictorsofleftventricularthrombusformationfollowingacutestsegmentelevationmyocardialinfarctionaserialcardiacmristudy
AT mosesdaniel incidenceandpredictorsofleftventricularthrombusformationfollowingacutestsegmentelevationmyocardialinfarctionaserialcardiacmristudy
AT schlaphoffglen incidenceandpredictorsofleftventricularthrombusformationfollowingacutestsegmentelevationmyocardialinfarctionaserialcardiacmristudy
AT losidney incidenceandpredictorsofleftventricularthrombusformationfollowingacutestsegmentelevationmyocardialinfarctionaserialcardiacmristudy
AT juergenscraig incidenceandpredictorsofleftventricularthrombusformationfollowingacutestsegmentelevationmyocardialinfarctionaserialcardiacmristudy
AT dimitrihany incidenceandpredictorsofleftventricularthrombusformationfollowingacutestsegmentelevationmyocardialinfarctionaserialcardiacmristudy
AT richardsdavid incidenceandpredictorsofleftventricularthrombusformationfollowingacutestsegmentelevationmyocardialinfarctionaserialcardiacmristudy
AT thomasliza incidenceandpredictorsofleftventricularthrombusformationfollowingacutestsegmentelevationmyocardialinfarctionaserialcardiacmristudy