Optimal Use of Echocardiography in Management of Thrombosis After Anterior Myocardial Infarction

Abstract

Despite advancement in therapy and management, left ventricular thrombus (LVT) after anterior myocardial infarction (MI) is sporadically encountered and remains associated with a very high risk of major cardiovascular events and mortality. Cardiac magnetic resonance (CMR) is considered the gold standard technique for LVT detection, but it is a time‐consuming and expensive test not available in all centers, especially when repeated examinations are necessary. Transthoracic echocardiography represents a useful tool to screen for LVT and to identify predictors of high risk of developing LVT. The advances in ultrasound technology and the use of contrast agents may potentially help clinicians to identify LVT and the use of sequential echocardiography for each patient with acute MI complicated by LVT may provide an opportunity to quantify regression and its correlation with outcomes to tailor the management of these patients. Hence, this narrative review focuses on the added value of echocardiographic‐guided LVT management in patients with recent anterior MI to reduce mortality and morbidity excess related to LVT based on current evidence.

Diagnostic Value of Echocardiography Combined with Serum h-FABP and cTnI in Myocardial Infarction and Its Evaluation Value in Left Ventricular Function

“…Traditional Chinese medicine treatment of AMI can protect damaged myocardium and improve myocardial function through local relief and systemic regulation. The patients were classified into Qi deficiency and blood stasis type, Qi deficiency and phlegm stasis type, heart Qi deficiency type, and heart Yang deficiency type as per the “Criteria Related to the Diagnostic Efficacy of Chinese Medicine Evidence” [ 1 ] and the relevant experience of AMI diagnosis. According to the general principle of “unblocking as the main treatment and tonification as supplement before surgery, and tonification as the main treatment and unblocking as supplement after surgery,” for patients with Qi deficiency and blood stasis type, 20 mL/d of Astragalus injection (equivalent to 40 g of the raw drug Astragalus) and compound Danshen injection (2 mL/stem, equivalent to raw drug containing 2 g each of Danshen and Radix et Rhizoma) were given intravenously to invigorate blood, benefit Qi, and clear stasis; for patients with Qi deficiency and phlegm stasis type, Astragalus injection 20 mL/d (equivalent to 40 g of raw Astragalus) was given intravenously to invigorate blood, benefit Qi, resolve phlegm, and clear the blood circulation; intravenous injection of Astragalus injection 20 mL/d (equivalent to 40 g of raw Astragalus) for patients with deficiency of heart Qi; ginseng and Sophora injection (red ginseng and black Sophora extracts, with main ingredients of ginsenoside >0.5 mg/mL and aconitine) was given intravenously for patients with the heart Yang deficiency type.…”

“…Acute myocardial infarction (AMI) is myocardial necrosis caused by acute and persistent ischemia and hypoxia of the coronary artery, with clinical manifestations of arrhythmia, acute circulatory dysfunction, chest pain, heart failure, and even shock, which impose a substantial threat on the life of patients [ 1 , 2 ]. Patients with AMI are usually accompanied by heart failure in which ventricular filling or ejection is impaired due to structural or functional abnormalities of the heart.…”

Integrated care for optimizing the management of stroke and associated heart disease: a position paper of the European Society of Cardiology Council on Stroke

“… 165–168 Since CMR is a time-consuming, expensive examination, not easily available in most centres, new approaches have been developed in the field of echocardiography, with ultrasound contrast agents significantly improving the diagnostic accuracy of TTE. 168 …”

“…For the DOACs, few data are available, limited to case reports and case series, and their use in this setting remains off-label. 168–170 …”

Echocardiographic Advances in Dilated Cardiomyopathy

“…Real-time 3D echo provides an unlimited number of cutting planes in all directions through a single full volume dataset that can be cropped and rotated improving sensitivity and reducing the risk of missing small apical thrombi [ 154 ]. However, this technique is not able to distinguish between LVT and myocardium or to evaluate the changes in thrombi structure, as the different shades of blue/brown color visualized by 3D echo reflect the depth of different structures rather than their texture [ 155 ]. Conversely, the myocardial deformation assessed by tissue Doppler imaging (TDI) using strain-rate (SR) techniques allows to differentiate between fresh (range: 5–27 days) and old (4–26 months) LVT [ 156 ].…”