Philippe Meurin1, Virginie Brandao Carreira2, Raphaelle Dumaine3, Alain Shqueir4, Olivier Milleron5, Benjamin Safar5, Sergio Perna6, Charles Smadja7, Marc Genest8, Jérome Garot9, Bernard Carette10, Laurent Payot11, Jean Yves Tabet12. 1. Centre de Réadaptation cardiaque de la Brie Les Grands Prés, 27 rue Sainte Christine, Villeneuve Saint Denis, France. Electronic address: philippemeurin@hotmail.com. 2. Marne La Vallée Hospital, 4 cours de Gondoire, Jossigny, France. 3. Centre de Réadaptation cardiaque de la Brie Les Grands Prés, 27 rue Sainte Christine, Villeneuve Saint Denis, France. 4. College National des Cardiologues Français and Cabinet Médical, Esbly, France. 5. Le Raincy-Montfermeil Hospital, 10 rue du Général Leclerc Montfermeil, France; Collège National des Cardiologues des Hôpitaux Français. 6. Meaux Hospital, 6 rue Saint Fiacre, Meaux, France. 7. Tournan Clinic, 2 rue Jules Lefebvre, Tournan en Brie, France. 8. Léon Binet Hospital, route Chalautre, Provins, France. 9. Private Hospital Jacques Cartier, CMR Department, Institut Cardiovasculaire Paris Sud-ICPS, Générale de Santé, 6 Ave du Noyer Lambert, Massy, France. 10. Courlancy Clinic, 38 rue Courlancy, Reims, France. 11. André Grégoire Hospital, 56 Boulevard de la Boissière, Montreuil sous bois, France. 12. Centre de Réadaptation cardiaque de la Brie Les Grands Prés, 27 rue Sainte Christine, Villeneuve Saint Denis, France; Private Hospital Jacques Cartier, CMR Department, Institut Cardiovasculaire Paris Sud-ICPS, Générale de Santé, 6 Ave du Noyer Lambert, Massy, France.
Abstract
BACKGROUND AND OBJECTIVES: We aimed to assess the incidence and evolution of left ventricular (LV) thrombi in a high-risk population of patients with LV systolic dysfunction after anterior myocardial infarction (ant-MI). We also compared the accuracy of transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging with contrast-delayed enhancement (CMR-DE) in detecting LV thrombi. METHODS: We prospectively included 100 consecutive patients with LV ejection fraction (LVEF) <45% at the first TTE performed <7 days after ant-MI. A second evaluation with TTE and CMR-DE (by blinded examiners) was performed at 30 days. A third TTE and assessment of clinical status were performed between 6 and 12 months after ant-MI. RESULTS: Patients (males 71%; mean age 59.1 ± 12.1 years; mean LVEF 33.5% ± 6.0%) were included at a median of 5.5 days (interquartile range 25th-75th percentile 4.25-6.0 days) after ant-MI. Thrombi were detected among 26 (26%) patients at a median of 12.0 days after ant-MI (7 patients at 1-7 days after MI; 15 at 8-30 days; and 4 after day 30). Sensitivity and specificity for LV thrombi detection were 94.7% and 98.5%, respectively, for TTE as compared with CMR-DE. Most thrombi (n = 24; 92.3%) disappeared after triple antithrombotic therapy (vitamin K antagonist in addition to dual antiplatelet therapy). CONCLUSION: Left ventricular thrombus is a frequent complication after ant-MI with systolic dysfunction. When a search for thrombus is prespecified, the accuracy of TTE is high as compared with CMR-DE. The best antithrombotic strategy is not known.
BACKGROUND AND OBJECTIVES: We aimed to assess the incidence and evolution of left ventricular (LV) thrombi in a high-risk population of patients with LV systolic dysfunction after anterior myocardial infarction (ant-MI). We also compared the accuracy of transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging with contrast-delayed enhancement (CMR-DE) in detecting LV thrombi. METHODS: We prospectively included 100 consecutive patients with LV ejection fraction (LVEF) <45% at the first TTE performed <7 days after ant-MI. A second evaluation with TTE and CMR-DE (by blinded examiners) was performed at 30 days. A third TTE and assessment of clinical status were performed between 6 and 12 months after ant-MI. RESULTS:Patients (males 71%; mean age 59.1 ± 12.1 years; mean LVEF 33.5% ± 6.0%) were included at a median of 5.5 days (interquartile range 25th-75th percentile 4.25-6.0 days) after ant-MI. Thrombi were detected among 26 (26%) patients at a median of 12.0 days after ant-MI (7 patients at 1-7 days after MI; 15 at 8-30 days; and 4 after day 30). Sensitivity and specificity for LV thrombi detection were 94.7% and 98.5%, respectively, for TTE as compared with CMR-DE. Most thrombi (n = 24; 92.3%) disappeared after triple antithrombotic therapy (vitamin K antagonist in addition to dual antiplatelet therapy). CONCLUSION: Left ventricular thrombus is a frequent complication after ant-MI with systolic dysfunction. When a search for thrombus is prespecified, the accuracy of TTE is high as compared with CMR-DE. The best antithrombotic strategy is not known.
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: 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
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Authors: Jie He; Heng Ge; Jian-Xun Dong; Wei Zhang; Ling-Cong Kong; Zhi-Qing Qiao; Ying Zheng; Song Ding; Fang Wan; Long Shen; Wei Wang; Zhi-Chun Gu; Fan Yang; Zheng Li; Jun Pu Journal: Ann Transl Med Date: 2020-03