Incidence, diagnostic methods, and evolution of left ventricular thrombus in patients with anterior myocardial infarction and low left ventricular ejection fraction: a prospective multicenter study

Meurin, Philippe; Carreira, Virginie Brandao; Dumaine, Raphaelle; Shqueir, Alain; Milleron, Olivier; Safar, Benjamin; Perna, Stefano; Smadja, Charles; Genest, Marc; Garot, Jérôme; Carette, B.; Payot, Laurent; Tabet, Jean-Yves

doi:10.1016/j.ahj.2015.04.029

Cited by 86 publications

(62 citation statements)

References 20 publications

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“…Ten studies [ 4 , 9 – 17 ] were included in the meta-analysis. The characteristics of these studies are summarized in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…The characteristics of these studies are summarized in Table 1 . The CMR scan was performed within the first week post-primary PCI in 7 studies [ 10 – 16 ], and between 7 and 30 days in 3 studies [ 4 , 9 , 17 ].…”

Section: Resultsmentioning

confidence: 99%

“… No patients with thromboembolic events at 6 months Surder 2015 [ 16 ] Substudy of SWISS-AMI study 177 anterior STEMI with LVEF< 45% Age: 57 ± 10 years Male: 85% DM: 11% Smoker: 59% MI size: 29 ± 12% CMR at a median of 6 (4–8)days Cine + LGE imaging 11/177 (6.2%) with LV thrombus All patients with LV thrombus were anticoagulated. Meurin 2015 [ 17 ] 100 anterior STEMI with LVEF< 45% Age: 59 ± 12 years Male: 71% DM: 20% Smoker: 43% LVEF: 33 ± 6% CMR at a median of 30 days (range 20–40 days) Cine + LGE imaging 26/100 (26%) with LV thrombus All patients with LV thrombus were started on anticoagulation STEMI ST-segment elevation myocardial infarction, DM diabetes mellitus, MI myocardial infarct, CMR cardiovascular magnetic resonance, RCT randomized controlled trial, LGE late gadolinium enhancement, LV left ventricular, LVEF left ventricular ejection fraction, MACE major adverse cardiovascular event, CCF congestive cardiac failure, FFP first pass perfusion …”

Section: Resultsmentioning

confidence: 99%

“…Three studies [ 15 – 17 ] included only patients with LVEF < 40–45%. One study [ 13 ] also reported the incidence of LV thrombus in those with anterior STEMI and LVEF< 50%.…”

Section: Resultsmentioning

confidence: 99%

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Incidence and predictors of left ventricular thrombus by cardiovascular magnetic resonance in acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: a meta-analysis

Bulluck

Chan

Paradies

et al. 2018

Journal of Cardiovascular Magnetic Resonance

109

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IntroductionThe incidence of left ventricular (LV) thrombus formation in ST-segment elevation myocardial infarction (STEMI) patients in the current era of primary percutaneous coronary intervention (PCI) is not well established. We performed a meta-analysis to assess the actual incidence and predictors of LV thrombus by cardiovascular magnetic resonance (CMR) in STEMI treated by primary PCI.MethodsWe searched MEDLINE and EMBASE databases up to February 2018. We included all studies published as a full-text article, reporting the incidence of LV thrombus by CMR within 1 month following acute STEMI in patients treated by primary PCI. A binary random-effects model was used to estimate the pooled incidence of LV thrombus. The diagnostic performance of transthoracic echocardiography (TTE) as compared with CMR was pooled to obtain the sensitivity and specificity of TTE with CMR as the gold standard. Embolic and bleeding complications of LV thrombus were also evaluated.ResultsTen studies were included in the meta-analysis. The incidence of LV thrombus by CMR in all-comer STEMI patients (n = 2072) was 6.3% with 96% of LV thrombus occurring in those with anterior STEMI (12.2% incidence). When only anterior STEMI with LVEF< 50% were considered (n = 447), the incidence of LV thrombus was 19.2%. Compared with CMR, the sensitivity of TTE to detect LV thrombus was 29% with a specificity of 98%. The sensitivity of TTE increased to 70% in those with anterior STEMI and reduced LVEF. LV thrombus resolved in 88% of cases by 3 to 6 months. After 1–2 years follow-up, the embolic complication rate was similar at 1.5% (P = 0.25) but the bleeding complication rate was significantly higher (8.8% versus 0.5%, P < 0.001) in the LV thrombus group on triple therapy when compared to the no LV thrombus group on dual antiplatelet therapy.ConclusionIn the primary PCI era, CMR detection of an LV thrombus post-STEMI remains high with incidence of nearly 20% in anterior STEMI with depressed LVEF. Patients with LV thrombus treated by triple therapy had similar embolic complications but higher bleeding complications than those with no LV thrombus treated with dual antiplatelet therapy. A 3 month follow-up CMR scan to guide anticoagulation duration might help mitigate bleeding risk.

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“…Ten studies [ 4 , 9 – 17 ] were included in the meta-analysis. The characteristics of these studies are summarized in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Three studies [ 15 – 17 ] included only patients with LVEF < 40–45%. One study [ 13 ] also reported the incidence of LV thrombus in those with anterior STEMI and LVEF< 50%.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Incidence and predictors of left ventricular thrombus by cardiovascular magnetic resonance in acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: a meta-analysis

Bulluck

Chan

Paradies

et al. 2018

Journal of Cardiovascular Magnetic Resonance

109

View full text Add to dashboard Cite

show abstract

“…Factors related to LV thrombus generation include acute myocardial infarction (MI), LV dysfunction, dilated cardiomyopathy, and coronary artery disease with cardiac wall hypokinesia or aneurysmal dilatation . A transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging with contrast‐delayed enhancement (CMR‐DE) study of patients with anterior MI and subsequent diminished LV ejection fraction identified cardiac thrombi in 26% of patients within a median of 12 days post MI . TEE is more efficient than TTE in identifying potential cardiac sources of cerebral embolism, because TTE might miss the majority of cardiac conditions considered as potential, or even as major embolic sources, including cardiac thrombi .…”

Section: Cardiac Sourcesmentioning

confidence: 99%

The Role of Transcranial Doppler Monitoring in Patients with Multi‐Territory Acute Embolic Strokes: A Review

Kargiotis

Psychogios

Safouris

et al. 2019

Journal of Neuroimaging

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Acute multi‐territory, embolic cerebral infarctions are often associated with serious underlying clinical conditions including the presence of highly “active” emboligenic sources causing that in turn may result in high early recurrence rates. Prompt diagnosis, risk stratification, and treatment are substantial for the prevention of subsequent embolization that would result in further clinical deterioration. Among other clinical investigations, transcranial Doppler (TCD) monitoring is highly efficacious for the detection of microembolic signals (MES) that correspond to microthrombi entering the intracranial circulation. The presence and burden of MES, especially in multiple intracranial arteries, is clearly associated with an increased risk of symptomatic, recurrent embolization, and thus can justify a more aggressive treatment approach (clopidogrel load followed by dual antiplatelet therapy or alternatively therapeutic dose of low‐molecular‐weight heparin). In this narrative review, we discuss the most important causes of multi‐territory embolic ischemic strokes and also underscore the utility of TCD as a noninvasive tool for the diagnosis, risk stratification, and treatment.

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Relationship of left ventricular thrombus formation and adverse outcomes in acute anterior myocardial infarction in patients treated with primary percutaneous coronary intervention

Zhang

Wang

Shi

et al. 2018

Clinical Cardiology

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Background: The incidence of left ventricular thrombus (LVT) is 4% to 15% in patients with anterior acute ST-segment elevation myocardial infarction (ant-AMI) in the era of primary percutaneous coronary intervention (PPCI). And patients with LVT have higher in-hospital mortality.Hypothesis: There is a relationship between LVT formation and 1-year major adverse cardiocerebrovascular events (MACCE) in patients with ant-AMI treated by PPCI. Methods:Our study population included 1488 consecutive patients with ant-AMI. The primary endpoint was the incidence of MACCE within 1 year after AMI. The secondary endpoint was the thrombosis disappearance.Results: A total of 106 (7.1%) patients were diagnosed with LVT and 1382 (92.9%) patients without LVT. Patients with LVT had a higher incidence of MACCE than in patients without LVT (21.7%vs10.3%; P < 0.001). Univariate analysis showed LVT was associated with an increase in MACCE risk (odds ratio [OR] = 2.40; 95% confidence interval ; P < 0.001).When examining MACCE components individually, LVT was only associated with the incidence of congestive heart failure (OR = 2.41; 95% CI [1.29-4.58]; P = 0.001). After adjustment for principal confounders, LVT remained an independent risk factor for MACCE (HR = 2.28; 95% CI [1.12-6.38]; P = 0.020). Other independent predictors include 24-hour LVEF, creatine kinase peak value, and age. Further analysis found patients with LVT in international normalized ratio (INR) ≥ 2 group had lower MACCE risk and higher thrombus disappearance than in INR < 2 group (13.5%vs29.6%; P = 0.044; 90.4%vs74.1%; P = 0.029). Conclusion:For patients with ant-AMI treated by PPCI, LVT is an independent predictor of 1-year MACCE events. Treatment with vitamin K antagonist in the therapeutic range (INR ≥ 2) has the potential to reduce MACCE risk and promote disappearance of thrombus. | INTRODUCTIONLeft ventricular thrombosis (LVT) is a common complication of anterior acute ST-segment elevation myocardial infarction (ant-AMI). In the early 1990s, 40% to 60% of patients with ant-AMI were found to be accompanied by LVT. 1,2 The development of primary percutaneous coronary intervention (PPCI) greatly reduced the infarct area and the formation of LVT. Despite progress made in decreasing formation of LVT, reports indicate thrombosis formation is between 4% and 15% in patients with ant-AMI after treatment with PPCI. [3][4][5] At present, the molecular mechanisms of LVT are unclear. Generally, LVT is believed to be associated with abnormal blood flow stagnation, injury to the endocardium, inflammatory cascade, and high coagulation state during myocardial infarction. Regardless of the treatment of myocardial infarction, risk factors for LVT usually include large infarct area, severe ventricular wall in coordination, and anterior wall myocardial infarction .1,4,6-8 Patients with ant-AMI are five times more likely to develop LVT than those with other types of ant-AMI.Furthermore, the incidence of LVT in patients with LVEF < 40% is higher than in patients with normal LVEF (10....

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Incidence, diagnostic methods, and evolution of left ventricular thrombus in patients with anterior myocardial infarction and low left ventricular ejection fraction: a prospective multicenter study

Cited by 86 publications

References 20 publications

Incidence and predictors of left ventricular thrombus by cardiovascular magnetic resonance in acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: a meta-analysis

Incidence and predictors of left ventricular thrombus by cardiovascular magnetic resonance in acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: a meta-analysis

The Role of Transcranial Doppler Monitoring in Patients with Multi‐Territory Acute Embolic Strokes: A Review

Relationship of left ventricular thrombus formation and adverse outcomes in acute anterior myocardial infarction in patients treated with primary percutaneous coronary intervention

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