Daniel Sürder1, Valentin Gisler2, Roberto Corti3, Tiziano Moccetti4, Catherine Klersy5, Michel Zuber6, Stephan Windecker7, Aris Moschovitis7, Sebastian Kozerke8, Thomas Felix Lüscher2, Paul Erne9, Robert Manka10. 1. Fondazione Cardiocentro Ticino, Lugano, Switzerland, and Department of Cardiology, Cardiovascular Centre, University Hospital Zurich, Switzerland. 2. Department of Cardiology, Cardiovascular Centre, University Hospital Zurich, Switzerland. 3. Department of Cardiology, Cardiovascular Centre, University Hospital Zurich, Switzerland, and Heart Clinic Hirslanden Zurich, Switzerland. 4. Fondazione Cardiocentro Ticino, Lugano, Switzerland. 5. IRCCS Fondazione Policlinico San Matteo, Servizio di Biometria e Statistica, Pavia, Italy. 6. Department of Cardiology, Cantonal Hospital Lucerne, Switzerland, and Cardiology, St. Anna Clinic Hirslanden Lucerne, Switzerland. 7. Department of Cardiology, Bern University Hospital, Switzerland. 8. Institute for Biomedical Engineering, University and ETH Zurich, Switzerland. 9. Department of Cardiology, Cantonal Hospital Lucerne, Switzerland, and Heart Clinic Hirslanden Zurich, Switzerland. 10. Department of Cardiology, Cardiovascular Centre, University Hospital Zurich, Switzerland, and Institute for Biomedical Engineering, University and ETH Zurich, Switzerland.
Abstract
INTRODUCTION: Left ventricular thrombus (LVT) formation may worsen the post-infarct outcome as a result of thromboembolic events. It also complicates the use of modern antiplatelet regimens, which are not compatible with long-term oral anticoagulation. The knowledge of the incidence of LVT may therefore be of importance to guide antiplatelet and antithrombotic therapy after acute myocardial infarction (AMI). METHODS: In 177 patients with large, mainly anterior AMI, standard cardiac magnetic resonance imaging (CMR) including cine and late gadolinium enhancement (LGE) imaging was performed shortly after AMI as per protocol. CMR images were analysed at an independent core laboratory blinded to the clinical data. Transthoracic echocardiography (TTE) was not mandatory for the trial, but was performed in 64% of the cases following standard of care. In a logistic model, 3 out of 61 parameters were used in a multivariable model to predict LVT. RESULTS: LVT was detected by use of CMR in 6.2% (95% confidence interval [CI] 3.1%-10.8%). LGE sequences were best to detect LVT, which may be missed in cine sequences. We identified body mass index (odds ratio 1.18; p = 0.01), baseline platelet count (odds ratio 1.01, p = 0.01) and infarct size as assessed by use of CMR (odds ratio 1.03, p = 0.02) as best predictors for LVT. The agreement between TTE and CMR for the detection of LVT is substantial (kappa = 0.70). DISCUSSION: 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.
INTRODUCTION:Left ventricular thrombus (LVT) formation may worsen the post-infarct outcome as a result of thromboembolic events. It also complicates the use of modern antiplatelet regimens, which are not compatible with long-term oral anticoagulation. The knowledge of the incidence of LVT may therefore be of importance to guide antiplatelet and antithrombotic therapy after acute myocardial infarction (AMI). METHODS: In 177 patients with large, mainly anterior AMI, standard cardiac magnetic resonance imaging (CMR) including cine and late gadolinium enhancement (LGE) imaging was performed shortly after AMI as per protocol. CMR images were analysed at an independent core laboratory blinded to the clinical data. Transthoracic echocardiography (TTE) was not mandatory for the trial, but was performed in 64% of the cases following standard of care. In a logistic model, 3 out of 61 parameters were used in a multivariable model to predict LVT. RESULTS: LVT was detected by use of CMR in 6.2% (95% confidence interval [CI] 3.1%-10.8%). LGE sequences were best to detect LVT, which may be missed in cine sequences. We identified body mass index (odds ratio 1.18; p = 0.01), baseline platelet count (odds ratio 1.01, p = 0.01) and infarct size as assessed by use of CMR (odds ratio 1.03, p = 0.02) as best predictors for LVT. The agreement between TTE and CMR for the detection of LVT is substantial (kappa = 0.70). DISCUSSION: 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.
Authors: Donya A Alhassan; Khawaja Bilal Waheed; Muhammad N Sharif; Muhammad Z Ul Hassan; Fazal Ghaffar; Khaled S Salem; Emad F M Said; Bayan M Altalaq; Ahmad O Qarmash; Zechariah J Arulanantham Journal: J Saudi Heart Assoc Date: 2020-08-17
Authors: Heerajnarain Bulluck; Mervyn H H Chan; Valeria Paradies; Robert L Yellon; He H Ho; Mark Y Chan; Calvin W L Chin; Jack W Tan; Derek J Hausenloy Journal: J Cardiovasc Magn Reson Date: 2018-11-08 Impact factor: 5.364