Thrombus formation in the left ventricle after large myocardial infarction – assessment with cardiac magnetic resonance imaging

Sürder, Daniel; Gisler, Valentin; Corti, Roberto; Moccetti, Tiziano; Klersy, Catherine; Züber, Michel; Windecker, Stephan; Moschovitis, Aris; Kozerke, Sebastian; Lüscher, Thomas F.; Erné, Paul; Manka, Robert

doi:10.4414/smw.2015.14122

Cited by 14 publications

(17 citation statements)

References 27 publications

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“…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%

“… Gellen 2017 [ 9 ] 265 anterior STEMI Age: 58 ± 12 years Male: 85% DM: 44% Smoker: 43% MI size: 31 ± 12% CMR within 21 days LGE imaging 34/265 (12.8%) with LV thrombus CMR ≤ 5 days: 13/160 CMR > 5 days: 21/105 The highest LV thrombus detection rate was in patients with CMR performed 9 to 12 days after STEMI Weir 2009 [ 15 ] 100 Acute MI (90 STEMI, 10 NSTEMI) with LVEF< 40% Age: 59 ± 12 years Male: 77% DM: 0% Smoker: 55% MI size: 33 ± 21 ml/m 2 CMR at a mean of 4.2 days (range 2–11 days) First-pass perfusion + LGE 15/100 (15%) with LV thrombus All anterior MI (15/55, 27.3%) All patients with LV thrombus were formally anticoagulated. 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%

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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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

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“…A bolus of a conventional extracellular gadolinium-chelates contrast medium at a dose of 0.20 mmol/kg of body weight was administered to assess myocardial scar imaging, by using an inversion recovery fast gradient echo imaging sequence. [25][26][27][28] Scar imaging was performed 20 minutes after administration of contrast medium in identical locations as functional data were acquired.…”

Section: Cmr Imagingmentioning

confidence: 99%

Effect of Bone Marrow–Derived Mononuclear Cell Treatment, Early or Late After Acute Myocardial Infarction

Sürder

Manka

Moccetti

et al. 2016

Circulation Research

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Rationale: Intracoronary delivery of autologous bone marrow–derived mononuclear cells (BM-MNC) may improve remodeling of the left ventricle (LV) after acute myocardial infarction (AMI). Objective: To demonstrate long-term efficacy of BM-MNC treatment after AMI. Methods and Results: In a multicenter study, we randomized 200 patients with large AMI in a 1:1:1 pattern into an open-labeled control and 2 BM-MNC treatment groups. In the BM-MNC groups, cells were either administered 5 to 7 days (early) or 3 to 4 weeks (late) after AMI. Cardiac magnetic resonance imaging was performed at baseline and after 12 months. The current analysis investigates the change from baseline to 12 months in global LV ejection fraction, LV volumes, scar size, and N-terminal pro-brain natriuretic peptide values comparing the 2 treatment groups with control in a linear regression model. Besides the complete case analysis, multiple imputation analysis was performed to address for missing data. Furthermore, the long-term clinical event rate was computed. The absolute change in LV ejection fraction from baseline to 12 months was −1.9±9.8% for control (mean±SD), −0.9±10.5% for the early treatment group, and −0.7±10.1% for the late treatment group. The difference between the groups was not significant, both for complete case analysis and multiple imputation analysis. A combined clinical end point occurred equally in all the groups. Overall, 1-year mortality was low (2.25%). Conclusions: Among patients with AMI and LV dysfunction, treatment with BM-MNC either 5 to 7 days or 3 to 4 weeks after AMI did not improve LV function at 12 months, compared with control. The results are limited by an important drop out rate. Clinical Trial Registration Information: URL: http://www.clinicaltrials.gov . Unique identifier: NCT00355186.

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“…In addition, CMR is the gold standard for the assessment of ejection fraction and cardiac chamber volumes as it offers the highest reproducibility among all imaging modalities. Furthermore, CMR uniquely enables myocardial tissue characterization, ischaemia/viability assessment, and confirmation of LV thrombus formation in one examination …”

Section: Imaging Before or After Dischargementioning

confidence: 99%

“…Furthermore, CMR uniquely enables myocardial tissue characterization, ischaemia/viability assessment, and confirmation of LV thrombus formation in one examination. 2,[53][54][55]…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Imaging in patients with suspected acute heart failure: timeline approach position statement on behalf of the Heart Failure Association of the European Society of Cardiology

Čelutkienė

Lainščak

Anderson

et al. 2019

European J of Heart Fail

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Acute heart failure is one of the main diagnostic and therapeutic challenges in clinical practice due to a non‐specific clinical manifestation and the urgent need for timely and tailored management at the same time. In this position statement, the Heart Failure Association aims to systematize the use of various imaging methods in accordance with the timeline of acute heart failure care proposed in the recent guidelines of the European Society of Cardiology. During the first hours of admission the point‐of‐care focused cardiac and lung ultrasound examination is an invaluable tool for rapid differential diagnosis of acute dyspnoea, which is highly feasible and relatively easy to learn. Several portable and stationary imaging modalities are being increasingly used for the evaluation of cardiac structure and function, haemodynamic and volume status, precipitating myocardial ischaemia or valvular abnormalities, and systemic and pulmonary congestion. This paper emphasizes the central role of the full echocardiographic examination in the identification of heart failure aetiology, severity of cardiac dysfunction, indications for specific heart failure therapy, and risk stratification. Correct evaluation of cardiac filling pressures and accurate prognostication may help to prevent unscheduled short‐term readmission. Alternative advanced imaging modalities should be considered to assist patient management in the pre‐ and post‐discharge phase, including cardiac magnetic resonance, computed tomography, nuclear studies, and coronary angiography. The Heart Failure Association addresses this paper to the wide spectrum of acute care and heart failure specialists, highlighting the value of all available imaging techniques at specific stages and in common clinical scenarios of acute heart failure.

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Thrombus formation in the left ventricle after large myocardial infarction – assessment with cardiac magnetic resonance imaging

Abstract: In the current analysis, the incidence of LVT shortly after AMI is relatively low, even in a patient population at high risk. An optimal modality for LVT detection is LGE-CMR but TTE has an acceptable accuracy when LGE-CMR is not available.

Cited by 14 publications

References 27 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

Effect of Bone Marrow–Derived Mononuclear Cell Treatment, Early or Late After Acute Myocardial Infarction

Imaging in patients with suspected acute heart failure: timeline approach position statement on behalf of the Heart Failure Association of the European Society of Cardiology

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