Timing of Cardiac Magnetic Resonance Imaging Impacts on the Detection Rate of Left Ventricular Thrombus After Myocardial Infarction

Gellen, Barnabas; Bière, Loïc; Logeart, Damien; Lairez, Olivier; Vicaut, Éric; Furber, Alain; Mercadier, Jean-Jacques; Sirol, Marc

doi:10.1016/j.jcmg.2016.12.006

Cited by 31 publications

(28 citation statements)

References 4 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%

“…392 STEMI (207 anterior) had paired acute and follow-up CMR Single centre Age: 58 ± 12 years Male: 82% DM: 19% Smoker: 60% MI size: 19 (10–30)% 1.5 T 7 ± 2 days and 6 months (those with LV thrombus were rescanned at 1 year (11/13) LGE imaging 574 with CMR at 1 week (LV thrombus 28–5%) 18 (5%) early LV thrombus and 9 (2%) late LV thrombus 4/18 (24%) still had LV thrombus at 6 months (anterior) 11 with LV thrombus at 6 months – 3/11 (27%) still had LV thrombus at 1 year (3/25–12%) LVEF< 50% and anterior STEMI independently predicted LV thrombus (c-statistic 0.82) Patients with anterior infarction and LVEF < 50% are at highest risk of developing LV thrombus (23/115, 20%). 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.…”

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%

See 1 more Smart Citation

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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“…Aligned with the results of this study, existing literature is consistent in reporting rates of definite LV thrombus between 3% and 9%, 4,7,27-29 with a time-dependent relationship in the development and less likelihood of detection if imaging is performed within 5 days of the infarct. 30 With echocardiograms in the current study performed within a median duration of 2 days of the infarct, the possibility that LV thrombi occurring later were missed, or that high-risk patients not discharged on prophylactic OAC could have developed LV thrombi during follow-up exists; nevertheless, the low clinical event rates during follow-up suggest that this possibility is low. The results of the current study also highlight that LV thrombus formation occurs independently of the baseline cardiac risk profile or total ischemic time and that regardless of the presence of LV thrombus, the 1-year ischemic composite in high-risk patients remains substantially elevated.…”

Section: Discussionmentioning

confidence: 68%

Outcomes and Prognostic Impact of Prophylactic Oral Anticoagulation in Anterior ST‐Segment Elevation Myocardial Infarction Patients With Left Ventricular Dysfunction

Shavadia

Youngson

Bainey

et al. 2017

JAHA

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BackgroundThe contemporary role of prophylactic anticoagulation following extensive anterior wall ST‐segment myocardial infarction (STEMI) is unclear.Methods and ResultsWe evaluated anterior STEMI patients with left ventricle dysfunction (left ventricular ejection fraction ≤40%) (“high risk”), categorized by prophylactic warfarin use, within a regional STEMI. Patients with pre‐existing atrial fibrillation were excluded. The primary outcome was an adjusted (for Global Registry of Acute Coronary Events risk score) 1‐year composite of recurrent ischemia, stroke/transient ischemic attack/systemic embolism, or all‐cause death. Of the 2032 STEMI admissions, 436 (21.5%) were high risk. After excluding 19 (4.4%) patients with definite left ventricle thrombus and 21 (4.8%) in‐hospital deaths (2 had left ventricle thrombus), prophylactic warfarin was utilized in 236/398 (59.3%) high‐risk survivors. Prescriptions were comparable across sex, but recipients were on average younger (58.5 years versus 64.0 years, P<0.001) and lower risk (Global Registry of Acute Coronary Events risk: 163 versus 181, P<0.001). No association on the adjusted ischemic composite (23.3% versus 25.3%, odds ratio 0.96, 95% CI 0.60–1.55) or thromboembolic events (2.1% versus 1.2%, odds ratio 1.99, 95% CI 0.38–10.51) was observed, but reduced 1‐year all‐cause mortality was noted (2.5% versus 8.6%, odds ratio 0.30, 95% CI 0.11–0.81); numerically higher major bleeding was observed at 1 year (2.5% versus 1.2%, odds ratio 2.17, 95% CI 0.43–10.96).ConclusionsA high utilization of prophylactic warfarin occurs in anterior STEMI patients with left ventricle dysfunction, yet appears to provide no additional benefit on the ischemic composite. The association with lower all‐cause mortality, but higher bleeding, calls for an improved understanding of its role in high‐risk STEMI.

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“…Of note, CE-CMR performed between 9 and 14 days post-MI provided the highest detection rate. 19,20 Despite its diagnostic superiority, CMR remains a time-consuming and expensive test, not available in all centers. Indeed, it is impractical to perform and repeat CMR in all patients with high-risk times after MI, performing repeated TTE rather than a single CE-CMR could have an even greater clinical impact in patients with satisfactory ultrasound quality.…”

Section: Iag Nos Ismentioning

confidence: 99%

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

et al. 2020

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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.

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Timing of Cardiac Magnetic Resonance Imaging Impacts on the Detection Rate of Left Ventricular Thrombus After Myocardial Infarction

Cited by 31 publications

References 4 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

Outcomes and Prognostic Impact of Prophylactic Oral Anticoagulation in Anterior ST‐Segment Elevation Myocardial Infarction Patients With Left Ventricular Dysfunction

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

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