E-wave propagation index as a marker for left ventricular thrombi post-ST elevation myocardial infarction

Abstract

Abstract Background The E-wave propagation index (EPI) is a novel echocardiographic measure for quantifying apical washout in the left ventricle (LV) and thus a promising marker of an elevated risk for LV thrombus. The association between EPI and LV thrombus has not been investigated in patients after ST-segment elevation myocardial infarction (STEMI). Purpose Aim was to determine, whether there is an association between EPI and LV thrombus development in STEMI patients treated with primary percutaneous coronary intervention (pPCI). Methods 665 STEMI patients treated with pPCI included in the prospective MARINA-STEMI cohort study (NCT04113356) were investigated. LV thrombus presence was diagnosed via contrast enhanced CMR a median of 4 (interquartile range [IQR] 3–5) days post-STEMI. EPI and left ventricular ejection fraction (LVEF) were measured using transthoracic echocardiography (TTE) a median of 2 ([IQR] 2–3) days post-STEMI. The longitudinal length of the LV was measured in the apical 4-chamber view at end-diastole. Velocity time integral (VTI) of the E-wave was measured using pulsed wave doppler. Results 5% (n=32) of the study population had a LV thrombus. Patients with LV thrombus had lower EPI values compared to patients without LV thrombus (0.92 vs 1.29, p<0.001). EPI (OR 0.21, 95% CI: 0.06-0.73, p<0.014), anterior infarct location (OR 17.18, 95 % CI: 2.25-131.05, p<0.006) and LVEF (OR 0.91, 95 % CI 0.86-0.95, p<0.001) were independently associated with LV thrombus. The optimal cut-off value for the prediction of LV thrombus prediction was an EPI <1 (sensitivity 56.3% and specificity 80.4%). 13% (n=18) of patients with an EPI <1 developed a LV thrombus compared to 3% (n=14) with an EPI≥1. Conclusion In STEMI patients treated with pPCI, a decreased EPI is a novel independent predictor for CMR verified LV thrombus. The optimal cut off for LV thrombus prediction is EPI <1.Center Image EPI