https://doi.org/10.4081/cardio.2024.43
New left ventricular thrombus and embolic events in left ventricular dysfunction postmyocardial infarction
Published: November 5, 2024
Abstract Views: 1401
PDF: 444
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Background: We aimed to assess the incidence and evolution of new left ventricular thrombus (LVT), and the incidence of manifest systemic embolism, in patients with severe left ventricular (LV) systolic dysfunction postacute anterior myocardial infarction (MI) who had been discharged on dual antiplatelet therapy. Methods: We prospectively included consecutive patients with postacute anterior MI and LV ejection fraction (LVEF) ≤35% or apical aneurysms or large infarctions with LVEF ≤40%. Transthoracic echocardiography (TTE) confirmed no LVT before hospital discharge, and a second TTE was performed at 30 days and a third one at 3 months. All TTE studies were prespecified to assess LVT, and the patients were screened for the development of clinically manifest systemic embolisms. Results: Two hundred and two consecutive patients (males 93%; mean age 55.2±6.4 years; mean LVEF 29.5±5.0%) were included. At 30 days (interquartile range: 2837 days), a new LVT was detected in 12 (5.9%) patients. Oral anticoagulant was added to all patients with LVT, and aspirin was continued in 5 (42.7%) patients for a month. The 3month TTE showed favorable evolution of LV size, LVEF and apical wall motion score index compared to the baseline. At 3 months, the LVT disappeared in 7 (58.3%) patients and 5 patients still had a mural LVT of smaller size, and none got new LVT. Among the group without LVT, one patient had a stroke, and another had a myocardial infarction and died. Conclusions: In contemporary practice, and using routine TTE, the incidence of new LVT in patients with severe LV dysfunction postacute anterior MI is low. They have a favorable LVT evolution with minor risk for clinically manifest systemic embolism.
1. Robinson AA, Jain A, Gentry M, McNamara RL. Left ventricular thrombi after STEMI in the primary PCI era: A systematic review and metaanalysis. Int J Cardiol 2016;221:5549.
DOI: https://doi.org/10.1016/j.ijcard.2016.07.069
2. Meurin P, Brandao Carreira V, Dumaine R, et al. Incidence, diagnostic methods, and evolution of left ventricular thrombus in patients with anterior myocardial infarction and low left ventricular ejection fraction: a prospective multicenter study. Am Heart J 2015;170:25662.
DOI: https://doi.org/10.1016/j.ahj.2015.04.029
3. Bulluck H, Chan MHH, Paradies V, et al. Incidence and predictors of left ventricular thrombus by cardiovascular magnetic resonance in acute STsegment elevation myocardial infarction treated by primary percutaneous coronary intervention: a metaanalysis. J Cardiovasc Magn Reson 2018;20:72.
DOI: https://doi.org/10.1186/s12968-018-0494-3
4. Saric M, Armour AC, Arnaout MS, et al. Guidelines for the use of echocardiography in the evaluation of a cardiac source of embolism. J Am Soc Echocardiogr 2016;29:142.
DOI: https://doi.org/10.1016/j.echo.2015.09.011
5. Weinsaft JW, Kim HW, Crowley AL, et al. LV thrombus detection by routine echocardiography. J Am Coll Cardiol Img 2011;4:70212.
DOI: https://doi.org/10.1016/j.jcmg.2011.03.017
6. Mollet NR, Dymarkowski S, Volders W, et al. Visualization of ventricular thrombi with contrastenhanced magnetic resonance imaging in patients with ischemic heart disease. Circulation 2002;106:28736.
DOI: https://doi.org/10.1161/01.CIR.0000044389.51236.91
7. Witt BJ, Brown RD Jr, Jacobsen SJ, Weston SA, Yawn BP, Roger VL. A communitybased study of stroke incidence after myocardialinfarction. Ann Intern Med 2005;143:78592.
DOI: https://doi.org/10.7326/0003-4819-143-11-200512060-00006
8. Stratton JR, Resnick AD. Increased embolic risk in patients with left ventricular thrombi. Circulation 1987;75:100411.
DOI: https://doi.org/10.1161/01.CIR.75.5.1004
9. Crawford TC, Smith WT, Velazquez EJ, Taylor SM, Jollis JG, Kisslo J. Prognostic usefulness of left ventricular thrombus by echocardiography in dilated cardiomyopathy in predicting stroke, transient ischemic attack, and death. Am J Cardiol 2004;93:5003.
DOI: https://doi.org/10.1016/j.amjcard.2003.10.056
10. Nihoyannopoulos P, Smith GC, Maseri A, Foale RA. The natural history of left ventricular thrombus in myocardial infarction: a rationale in support of masterly inactivity. J Am Coll Cardiol 1989;14:90311.
DOI: https://doi.org/10.1016/0735-1097(89)90463-4
11. Ciaccheri M, Castelli G, Cecchi F, et al. Lack of correlation between intracavitary thrombosis detected by cross sectional echocardiography and systemic emboli in patients with dilated cardiomyopathy. Br Heart J 1989;62:269.
DOI: https://doi.org/10.1136/hrt.62.1.26
12. Vaitkus PT, Barnathan ES. Embolic potential, prevention and management of mural thrombus complicating anterior myocardial infarction: a metaanalysis. J Am Coll Cardiol 1993;22:10049.
DOI: https://doi.org/10.1016/0735-1097(93)90409-T
13. Andreotti F, Testa L, BiondiZoccai GG, Crea F. Aspirin plus warfarin compared to aspirin alone after acute coronary syndromes: an updated and comprehensive metaanalysis of 25,307 patients.
Eur Heart J 2006;27:51926.
14. O'Gara PT, Kushner FG, Ascheim DD, et al. ACCF/AHA guideline for the management of STelevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;61:e78140.
15. Ibanez B, James S, Agewall S, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with STsegment elevation: the task force for the management of acute myocardial infarction in patients presenting with STsegment elevation of the European Society of Cardiology (ESC). Eur Heart J 2017;39:11977.
16. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction. Circulation 2018;138:e61851.
DOI: https://doi.org/10.1161/CIR.0000000000000617
17. Kleindorfer DO, Towfighi A, Chaturvedi S, et al. Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association. Stroke 2021;52:e364467.
DOI: https://doi.org/10.1161/STR.0000000000000375
18. Lang RM, Badano LP, MorAvi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the
European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28:139.
19. Domenicucci S, Chiarella F, Bellotti P, Bellone P, Lupi G, Vecchio C. Longterm
prospective assessment of left ventricular thrombus in anterior wall acute myocardial infarction and implications for a rational approach to embolic risk. Am J Cardiol 1999;83:51924.
DOI: https://doi.org/10.1016/S0002-9149(98)00906-0
20. Zwart B, Bor WL, de Veer AJ, et al. A novel risk score to identify the need for triple antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention: a post hoc analysis of the REDUAL PCI trial. EuroIntervention 2022;18:e292302.
DOI: https://doi.org/10.4244/EIJ-D-21-00165
21. Lip GY, Windecker S, Huber K, et al. Management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary or valve interventions: a joint consensus document of the European Society of Cardiology Working Group on Thrombosis, European Heart Rhythm Association (EHRA), European Association of Percutaneous Cardiovascular Interventions (EAPCI) and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS) and AsiaPacific Heart Rhythm Society (APHRS). Eur Heart J 2014;35:315579.
DOI: https://doi.org/10.1093/eurheartj/ehu298
22. Khoury S, Carmon S, Margolis G, Keren G, Shacham Y. Incidence and outcomes of early left ventricular thrombus following STelevation myocardial infarction treated with primary percutaneous coronary intervention. Clin Res Cardiol 2017;106:695701.
DOI: https://doi.org/10.1007/s00392-017-1111-4
23. Altintaş B, Altindağ R, Bilge Ö, et al. The effect of ticagrelorbased dual antiplatelet therapy on the development of late left ventricular thrombus after acute anterior STelevation myocardial infarction. Int J Cardiol 2019;287:1926.
DOI: https://doi.org/10.1016/j.ijcard.2019.04.010
24. Bastiany A, Matteau A, ElTuraby F, et al. Comparison of systematic ticagrelor-based dual antiplatelet therapy to selective triple antithrombotic therapy for left ventricle dysfunction following anterior STEMI. Sci Rep 2018;8:10326.
DOI: https://doi.org/10.1038/s41598-018-28676-4
25. Shavadia JS, Youngson E, Bainey KR, Bakal J, Welsh RC. Outcomes and prognostic impact of prophylactic oral anticoagulation in anterior STsegment elevation myocardial infarction patients with left ventricular dysfunction. J Am Heart Assoc 2017;6:e006054.
DOI: https://doi.org/10.1161/JAHA.117.006054
26. Oyetayo OO, Slicker K, De La Rosa L, et al. Dual antiplatelet compared to triple antithrombotic therapy in anterior wall acute myocardial infarction complicated by depressed left ventricular ejection fraction. Proc (Bayl Univ Med Cent) 2015;28:4459.
DOI: https://doi.org/10.1080/08998280.2015.11929303
27. Moulson N, LaHaye SA, Bertrand OF, MacHaalany J. Prophylactic warfarin post anterior STelevation myocardial infarction: a systematic review and metaanalysis. Cardiovasc Revasc Med 2017;18:55964.
DOI: https://doi.org/10.1016/j.carrev.2017.05.002
28. Delewi R, Nijveldt R, Hirsch A, Marcu CB, Robbers L, et al. Left ventricular thrombus formation after acute myocardial infarction as assessed by cardiovascular magnetic resonance imaging. Eur J Radiol 2012;81:39004.
DOI: https://doi.org/10.1016/j.ejrad.2012.06.029
29. Zhang Z, Si D, Zhang Q, et al. Prophylactic rivaroxaban therapy for left ventricular thrombus after anterior STsegment elevation myocardial infarction. JACC Cardiovasc Interv 2022;15:86172.
DOI: https://doi.org/10.1016/j.jcin.2022.01.285
30. Asinger RW, Mikell FL, Elsperger J, Hodges M. Incidence of leftventricular thrombosis after acute transmural myocardial infarction. Serial evaluation by twodimensional echocardiography. N Engl J Med 1981;305:297302.
DOI: https://doi.org/10.1056/NEJM198108063050601
31. Küpper AJ, Verheugt FW, Peels CH, Galema TW, Roos JP. Left ventricular thrombus incidence and behavior studied by serial twodimensional echocardiography in acute anterior myocardial infarction: left ventricular wall motion, systemic embolism and oral anticoagulation. J Am Coll Cardiol 1989;13:151420.
DOI: https://doi.org/10.1016/0735-1097(89)90341-0
How to Cite
Youssef, A. A., Al-Omani, S., Alrefae, M. A., Suliman, A., Hassan, R., Saleh, O., & Khalifa, Z. S. (2024). New left ventricular thrombus and embolic events in left ventricular dysfunction postmyocardial infarction. Global Cardiology, 2(3). https://doi.org/10.4081/cardio.2024.43
Copyright (c) 2024 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
