INTRODUCTION: Left ventricular (LV) thrombus formation is a feared complication of myocardial infarction (MI). We assessed the prevalence of LV thrombus in ST-segment elevated MI patients treated with percutaneous coronary intervention (PCI) and compared the diagnostic accuracy of transthoracic echocardiography (TTE) to cardiovascular magnetic resonance imaging (CMR). Also, we evaluated the course of LV thrombi in the modern era of primary PCI. METHODS: 200 patients with primary PCI underwent TTE and CMR, at baseline and at 4 months follow-up. Studies were analyzed by two blinded examiners. Patients were seen at 1, 4, 12, and 24 months for assessment of clinical status and adverse events. RESULTS: On CMR at baseline, a thrombus was found in 17 of 194 (8.8%) patients. LV thrombus resolution occurred in 15 patients. Two patients had persistence of LV thrombus on follow-up CMR. On CMR at four months, a thrombus was found in an additional 12 patients. In multivariate analysis, thrombus formation on baseline CMR was independently associated with, baseline infarct size (g) (B=0.02, SE=0.02, p<0.001). Routine TTE had a sensitivity of 21-24% and a specificity of 95-98% compared to CMR for the detection of LV thrombi. Intra- and interobserver variation for detection of LV thrombus were lower for CMR (κ=0.91 and κ=0.96) compared to TTE (κ=0.74 and κ=0.53). CONCLUSION: LV thrombus still occurs in a substantial amount of patients after PCI-treated MI, especially in larger infarct sizes. Routine TTE had a low sensitivity for the detection of LV thrombi and the interobserver variation of TTE was large.
INTRODUCTION:Left ventricular (LV) thrombus formation is a feared complication of myocardial infarction (MI). We assessed the prevalence of LV thrombus in ST-segment elevated MI patients treated with percutaneous coronary intervention (PCI) and compared the diagnostic accuracy of transthoracic echocardiography (TTE) to cardiovascular magnetic resonance imaging (CMR). Also, we evaluated the course of LV thrombi in the modern era of primary PCI. METHODS: 200 patients with primary PCI underwent TTE and CMR, at baseline and at 4 months follow-up. Studies were analyzed by two blinded examiners. Patients were seen at 1, 4, 12, and 24 months for assessment of clinical status and adverse events. RESULTS: On CMR at baseline, a thrombus was found in 17 of 194 (8.8%) patients. LV thrombus resolution occurred in 15 patients. Two patients had persistence of LV thrombus on follow-up CMR. On CMR at four months, a thrombus was found in an additional 12 patients. In multivariate analysis, thrombus formation on baseline CMR was independently associated with, baseline infarct size (g) (B=0.02, SE=0.02, p<0.001). Routine TTE had a sensitivity of 21-24% and a specificity of 95-98% compared to CMR for the detection of LV thrombi. Intra- and interobserver variation for detection of LV thrombus were lower for CMR (κ=0.91 and κ=0.96) compared to TTE (κ=0.74 and κ=0.53). CONCLUSION:LV thrombus still occurs in a substantial amount of patients after PCI-treated MI, especially in larger infarct sizes. Routine TTE had a low sensitivity for the detection of LV thrombi and the interobserver variation of TTE was large.
Authors: Pratik S Velangi; Christopher Choo; Ko-Hsuan A Chen; Felipe Kazmirczak; Prabhjot S Nijjar; Afshin Farzaneh-Far; Osama Okasha; Mehmet Akçakaya; Jonathan W Weinsaft; Chetan Shenoy Journal: Circ Cardiovasc Imaging Date: 2019-11-11 Impact factor: 7.792
Authors: Jonathan W Weinsaft; Jiwon Kim; Chaitanya B Medicherla; Claudia L Ma; Noel C F Codella; Nina Kukar; Subhi Alaref; Raymond J Kim; Richard B Devereux Journal: JACC Cardiovasc Imaging Date: 2015-10-14
Authors: Ola O Oyetayo; Kipp Slicker; Lisa De La Rosa; Wesley Lane; Dane Langsjoen; Chhaya Patel; Kevin Brough; Jeffrey Michel; Christopher Chiles Journal: Proc (Bayl Univ Med Cent) Date: 2015-10
Authors: Adam M Garber; Robert J Mentz; Hussein R Al-Khalidi; Linda K Shaw; Mona Fiuzat; Christopher M O'Connor; Eric J Velazquez Journal: J Thromb Thrombolysis Date: 2016-04 Impact factor: 2.300
Authors: Gianluca Pontone; Patrizia Carità; Mark G Rabbat; Marco Guglielmo; Andrea Baggiano; Giuseppe Muscogiuri; Andrea I Guaricci Journal: Curr Cardiol Rep Date: 2017-08-31 Impact factor: 2.931