Left Ventricular Thrombus Formation Research Articles

Abstract 13758: Right Ventricular Dysfunction Contributes to Left Ventricular Thrombus Formation After Myocardial Infarction

Introduction: Thromboembolic events such as stroke due to left ventricular thrombus (LVT) formation accompany acute myocardial infarction (MI). Risk factors for the development of LVT after MI have been identified based on limited data, including MI location, severe ventricular wall motion abnormalities or aneurysm, and reduced left ventricular ejection fraction (LVEF). Hypothesis: The purpose of this study was to define additional determinants of LVT formation following acute anterior MI through comparing clinical and echocardiographic characteristics between patients with and without LVT formation during the first 3 months after MI. Methods: This case-control-study comprised acute anterior MI patients with and without LVT, who were selected from a cohort of 1327 consecutive patients with ischemic heart failure in our hospital. The cases and controls were matched for age, sex, and LVEF. LVT was detected by routine/contrast echocardiography or cardiac magnetic resonance imaging during the first 3 months following MI. Results: Formation of apical aneurysm after MI was independently associated with LVT formation (72.0% vs. 43.5%, odds ratio [OR]=5.06, P=0.005). Echocardiographic risk factors associated with LVT formation included reduced mitral annular plane systolic excursion (MAPSE<7mm, OR=4.69), moderate-severe diastolic dysfunction (OR=2.71), and right ventricular (RV) dysfunction [reduced tricuspid annular plane systolic excursion (TAPSE)<17mm (OR=5.48), reduced RV factional area change (RV_FAC)<0.35 (OR=3.32), and enlarged RV diameters (OR=1.62)]. Subgroup analysis showed reduced TAPSE (OR=5.12, P=0.010) associated with increased risk of LVT formation in anterior MI patients without apical aneurysm, independent of clinical and other echocardiographic covariates. Conclusions: RV dysfunction as determined by reduced TAPSE and RV_FAC is independently associated with LVT formation in acute anterior MI patients, especially in the setting of MI patients without the formation of an apical aneurysm. This suggests that besides assessment of left ventricular abnormalities, assessment of concomitant RV dysfunction is of importance in risk stratification of LVT formation in patients with acute anterior MI.

Abstract 13829: Association Between E-wave Propagation Index and Left Ventricular Thrombus Formation in Systolic Heart Failure

Background: The E-wave propagation index (EPI) is a measure of apical blood flow and has been proposed as a risk marker of left ventricular thrombus (LVT) formation. We sought to investigate the association between EPI and LVT in patients with heart failure with reduced ejection fraction (HFrEF). Methods: This was a retrospective cohort study of patients with HFrEF. Follow-up echocardiograms were investigated for development of LVT. EPI was measured at baseline investigation as the velocity time integral of the transmitral E-wave divided by the left ventricular length. Logistic regression was used to investigate the association between EPI and LVT. Multivariable adjustments were made for age, significant mitral regurgitation, apical aneurysm, prior myocardial infarction, and left ventricular ejection fraction (LVEF). Results: Of 785 patients, 24 (3%) developed LVT. Mean age was 66 years, 73% were men, and LVEF was 28%. Those who developed LVT had significantly lower EPI (1.12 vs. 1.36, p=0.02). EPI was significantly associated with LVT in univariable logistic regression (OR=1.16 (1.03-1.31), per 0.1 decrease) (figure). These findings were unchanged after multivariable adjustments (OR=1.15 (1.00-1.31), per 0.1 decrease). The EPI provided an area under the curve of 0.68 with an optimal cutoff of 1.2. This cutoff had a sensitivity of 75%, specificity of 60%, positive predictive value of 6%, and negative predictive value of 99%. A low EPI was associated with a more than 4-fold increased risk of LVT (OR=4.56 (1.79-11.62), p=0.001). Conclusion: Decreasing EPI is associated with a higher risk of LVT. While a low EPI poses a markedly increased risk of LVT, a high EPI may be used to rule out LVT.

Abstract 11251: Warfarin versus Direct Oral Anticoagulants for the Treatment of Left Ventricular Thrombus; A Multicenter Retrospective Observational Study

Introduction: Left Ventricular (LV) thrombus formation is seen in some patients with severely reduced ejection fraction. Current guidelines recommend the use of warfarin in patients with LV thrombus. However, safe and effective warfarin use is often inconvenient and burdensome to some patients. Hypothesis: Direct oral anticoagulants (DOACs) are as effective as warfarin in the treatment of LV thrombus. Methods: We performed a multicenter retrospective analysis of adults admitted between January 2015 and December 2021 and diagnosed with LV thrombus. The primary outcome was thrombus resolution. Secondary outcomes included all-cause mortality, bleeding events and stroke or systemic embolism (SSE). Chi-square test was used to compare categorical variables. T-test was used for continuous variables comparison. Logistic regression was used to evaluate primary and secondary outcomes to control confounding factors such as demographic and comorbidity information. Results: A total of 194 patients were included, 48 (24.7%) of whom were treated with DOACs. The mean age was 61.6 ±13.3 years and 46 (23.7%) of the population were females. The two arms had no significant differences in age, sex, BMI, CHA2DS2-VASc score, history of DM, HTN, atrial fibrillation or ischemic cardiomyopathy. The rate of thrombus resolution (DOACs 58.3% vs warfarin 66.4%, p=0.309) and bleeding events (DOACs 14.6% vs warfarin 13.7%, p=0.878) were similar in both arms. The rate of SSE was numerically lower in the DOACs arm without statistical significance (DOACs 8.3% vs warfarin 15.07%, p=0.309). All-cause mortality was significantly higher in the DOACs arm (DOACs 22.9% vs warfarin 10.3%, p=0.026). In multivariate analysis, there was no significant effect of using warfarin on thrombus resolution, all-cause mortality, bleeding evens, and SSE (Figure). Conclusions: In our retrospective analysis, DOACs had similar efficacy and safety when compared to warfarin in the treatment of LV thrombus.

The relationship between CHA2DS2VASc score and left ventricular apical thrombus formation in patients with acute anterior ST segment elevation myocardial infarction

Background Left ventricular apical thrombus (LVAT) formation is a well-known complication of acute anterior myocardial infarction (AMI). The CHA2DS2VASc is a scoring system that has been used to estimate the risk of thromboembolism in patients with nonvalvular atrial fibrillation. This score has also been used for other clinical conditions. The aim of this study was to investigate the relationship between CHA2DS2VASc score and development of LVAT in patients with AMI. Method The study population included 378 patients (mean age: 56.5 ± 12.3 years, male: 318) presenting with AMI between January 2016 and January 2020. Primary percutaneous coronary intervention procedure was performed in all patients. Initial echocardiogram was performed within 7 days of admission. All patients were evaluated with echocardiography at 3rd, 6th and 12th months. Patients were divided into two groups according to the presence of LVAT on echocardiography. Results The incidence of the LVAT was 8.5% (n = 32) during a mean follow-up time of 233.1 ± 66.7 days. The mean CHA2DS2VASc score was notably higher in patients with LVAT compared to patients in the control group (3.1 ± 1.9 vs. 1.9 ± 1.2, p < 0.001). In Cox regression analysis, high CHA2DS2VASc score, low left ventricular ejection fraction (LVEF) and the presence of LV apical akinesis/aneurysm were the independent predictors for LVAT formation. All of these parameters were associated with higher cumulative incidence of LVAT formation in Kaplan-Meier analyses (p < 0.001 for all). Conclusion High CHA2DS2VASc score, low LVEF and the presence of LV apical akinesis/aneurysm may be used for LVAT risk prediction among patients presenting with AMI.

Association of whole blood viscosity with thrombus presence in patients undergoing transoesophageal echocardiography.

Whole blood viscosity (WBV) is considered as a reasonable proxy measure of blood flow, and it has been investigated in different cohort settings, including in patients with deep venous thrombosis, arterial thrombosis, acute stent thrombosis, and left ventricular apical thrombus formation following acute coronary syndrome. To determine the association between WBV and the presence of thrombus in the left atrium (LA) or left atrial appendage (LAA) in individuals who had transoesophageal echocardiography (TEE). The clinical data from 262 consecutive patients who had TEE at our facility were included in this retrospective cohort study. WBV was determined at both a high shear rate (HSR) and low shear rate (LSR) using hematocrit and total protein levels. In 22 cases (8.3%), the thrombus was detected. According to multivariable analyses, WBV at HSR and LSR were independently linked with thrombus detection in TEE. In a receiver operating characteristic (ROC) analysis, the area under curve (AUC) values of WBV at HSR and LSR were 0.77 and 0.76, respectively. To predict the presence of thrombus in TEE; the ideal value of WBV at HSR was > 16.6 with 81% sensitivity and 69% specificity and the ideal value of WBV at LSR was > 51.4 with 81% sensitivity and 70% specificity. This was the first study to indicate that significantly higher levels of WBV at both the HSR and LSR were linked to the presence of thrombus in the LA and LAA in cases who underwent TEE.

Risk factors for left ventricular thrombus formation on transthoracic echocardiography in a propensity-matched case control study

Abstract Introduction The specific risk factors for left ventricular thrombus (LVT) formation on transthoracic echocardiography (TTE) independent of age, sex, and left ventricular ejection fraction (LVEF) remain uncertain. Purpose To conduct a propensity-matched case control study of LVT. Methods We queried structured TTE report data from 113,673 patients at our institution to identify individuals with LVT on TTE, 2000–2011. Cases were matched 1:1 with controls on age, sex, LVEF, inpatient/outpatient status, image quality, test year, blood pressure, heart rate, height, and weight. using propensity scores. Risk factors for LVT formation were determined using medical chart review. Results Over 12 years, we identified 132 patients with LVT and 132 matched controls (mean age 62.0±16.1 years, 73.1% male, mean LVEF 27.0% ± 16.0%). Cases were similar to controls across all matched variables except height (cases vs. controls, mean height 172.2±8.8 vs. 174.8±9.3 cm, p=0.03). Compared with controls, TTEs for cases were more frequently performed for the indications of myocardial infarction (MI; 28.0% vs. 9.9%, p&amp;lt;0.001) and source of embolism (3.8% vs. 0.0%, p=0.008). Despite no differences between cases and controls in rates of hypertension, hyperlipidemia, diabetes, and thrombophilia (Table), a history of peripheral arterial disease was associated with a 3.4-fold increased odds of LVT formation (univariate odds ratio [OR], 3.35, 1.50–7.47, p=0.003). This association persisted despite adjustment for history of MI, stroke, height, history of recent major bleeding, and receipt of percutaneous coronary intervention (PCI) (adjusted OR, 4.33, 1.66–11.29, p=0.003). On presentation, 22.0% of cases were on anticoagulation including 20.5% on warfarin, none on a direct oral anticoagulant (DOAC), and 1.5% on heparin products. Additionally, 48.5% of cases were on antiplatelet medications. Of the 27 patients on warfarin on diagnosis of LVT, 25.9% had an International Normalized Range (INR) value &amp;lt;2.0. All TTE parameters were similar across groups (p&amp;gt;0.05 for all). Of those with LVT, 54 (40.9%) had LVT resolution over a median of 4.4 (0.9 to 13.6) months. Conclusions In this single center, propensity-matched case-control study of individuals with LVT on TTE, a history of peripheral arterial disease was associated with a 4.3-fold increased odds of LVT formation independent of age, sex, LVEF, history of MI, stroke, or PCI. Of those with LVT, anticoagulation was used on presentation in 22.0%. Nearly half had LVT resolution within 4.4 months. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The project was funded by a grant from the National, Heart, Lung, and Blood Institute (1K23HL144907 - Strom).

IDENTIFYING SOCIODEMOGRAPHIC, CLINICAL, AND ECHOCARDIOGRAPHIC PROFILES RELATED TO LEFT VENTRICULAR THROMBI FORMATION IN A SAFETY NET HOSPITAL

TOPIC: Cardiovascular Disease TYPE: Original Investigations PURPOSE: Left ventricular thrombus (LVT) formation is associated with significant morbidity and mortality owing to the risk of thromboembolism. LVT has been studied extensively in relation to myocardial infarction (MI); however, few studies have identified the clinical, sociodemographic, and echocardiographic risk factors associated with clot formation. We aimed to identify and compare sociodemographic, clinical, and echocardiographic risk factors associated with LVT formation in a safety net hospital. METHODS: A database of 30,468 transthoracic echocardiogram (TTE) reports were surveyed retrospectively for the word "clot," "thrombus," "thrombi," from 2012-2018. Indications for TTE included suspicion of LVT and comorbidities often associated with LVT including myocardial infarction (MI), cardiac arrhythmias (i.e. atrial fibrillation, atrial flutter), cerebrovascular accidents (i.e. stroke, transient ischemic attacks). Several sociodemographic, clinical, and echocardiographic criteria were compiled based on availability and analyzed via t-tests for normal distributions, Mann-Whitney u test for non-normal distributions, and chi-squared tests for categorical variables comparing those with and without thrombi. Multivariate analysis was then used to identify independent risk factors. RESULTS: We identified 224 patients that were being investigated for LVT, of which 5 cases were excluded due to workup of right ventricular thrombus. Out of 219 patients, 72 patients had LVT while the other 147 did not have LVT, and were used as our control group. Patients with LVT were predominantly male (88% vs. 64%, p<0.001), undomiciled (15% vs. 5%, P=0.006), had a history of MI (44% vs. 16%, p<0.001), or a history of methamphetamine use (17% vs. 9%, p=0.087). A majority of patients with non-ischemic cardiomyopathy (NICM) did not have LVT formation (49% vs. 59%, p<0.001) whereas individuals with ischemic cardiomyopathy (ICM) tended to have higher rates of LVT formation (47% vs. 22%, p=0.002). LVT was noted primarily in patients with left ventricular ejection fraction (LVEF) < 40% (89% vs. 34% p<0.001) and regional wall motion abnormalities (32% vs. 14%, p<0.001) among other echocardiographic findings, patients with LVT had differences in mean end diastolic diameter (p=0.001), mean stroke volume (p=0.001), and mean mitral valve E/A ratio (p<0.001). Using multivariate analysis, male gender and moderate or severe impairment of LVEF were independently associated with LVT. CONCLUSIONS: Male sex, moderate and severe left ventricular systolic dysfunction, regardless of etiology are independently associated with LVT in a cohort of patients seen at a safety net hospital. The current study adds to the data available on potential risk factors that may portend LVT formation. CLINICAL IMPLICATIONS: Identification of clinical, echocardiographic and sociodemographic risk factors of left ventricular thrombus and patients at risk for screening DISCLOSURES: No relevant relationships by Rahul Ahuja, source=Web Response No relevant relationships by Shahad Al Chalaby, source=Web Response No relevant relationships by Sophie Barbant, source=Web Response No relevant relationships by Ghita Bouzarif, source=Web Response No relevant relationships by Steve Kong, source=Web Response No relevant relationships by Saba Lahsaei, source=Web Response No relevant relationships by Katherine leger, source=Web Response No relevant relationships by Kala Mehta, source=Web Response No relevant relationships by Marina Trilesskaya, source=Web Response

Echocardiographic risk factors of left ventricular thrombus in patients with acute anterior myocardial infarction.

AimsThis study aimed to identify echocardiographic determinants of left ventricular thrombus (LVT) formation after acute anterior myocardial infarction (MI).Methods and resultsThis case–control study comprised 55 acute anterior MI patients with LVT as cases and 55 acute anterior MI patients without LVT as controls, who were selected from a cohort of consecutive patients with ischemic heart failure in our hospital. The cases and controls were matched for age, sex, and left ventricular ejection fraction. LVT was detected by routine/contrast echocardiography or cardiac magnetic resonance imaging during the first 3 months following MI. Formation of apical aneurysm after MI was independently associated with LVT formation [72.0% vs. 43.5%, odds ratio (OR) = 5.06, 95% confidence interval (CI) 1.65–15.48, P = 0.005]. Echocardiographic risk factors associated with LVT formation included reduced mitral annular plane systolic excursion (<7 mm, OR = 4.69, 95% CI 1.84–11.95, P = 0.001), moderate–severe diastolic dysfunction (OR = 2.71, 95% CI 1.11–6.57, P = 0.028), and right ventricular (RV) dysfunction [reduced tricuspid annular plane systolic excursion < 17 mm (OR = 5.48, 95% CI 2.12–14.13, P < 0.001), reduced RV fractional area change < 0.35 (OR = 3.32, 95% CI 1.20–9.18, P = 0.021), and enlarged RV mid diameter (per 5 mm increase OR = 1.62, 95% CI 1.12–2.34, P = 0.010)]. Reduced tricuspid annular plane systolic excursion (<17 mm) significantly associated with increased risk of LVT in anterior MI patients (OR = 3.84, 95% CI 1.37–10.75, P = 0.010), especially in those patients without apical aneurysm (OR = 5.12, 95% CI 1.45–18.08, P = 0.011), independent of body mass index, hypertension, anaemia, mitral annular plane systolic excursion, and moderate–severe diastolic dysfunction.ConclusionsRight ventricular dysfunction as determined by reduced TAPSE or RV fractional area change is independently associated with LVT formation in acute anterior MI patients, especially in the setting of MI patients without the formation of an apical aneurysm. This study suggests that besides assessment of left ventricular abnormalities, assessment of concomitant RV dysfunction is of importance on risk stratification of LVT formation in patients with acute anterior MI.

Macrophage depletion impairs adequate cardiac repair in mouse models of myocardial infarction with variable transmurality - insights from multimodality molecular imaging

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Deutsche Forschungsgemeinschaft (DFG) Introduction Balanced myocardial tissue inflammation following acute myocardial infarction (MI) is needed for optimal cardiac repair. Macrophages contribute to wound healing, but may also be deleterious. Purpose We investigated the impact of macrophage depletion on early cardiac inflammation and later functional outcome in two models of MI with variable transmurality. Methods C57BL/6N mice received clodronate-liposomes for macrophage depletion (n = 49) or control PBS-liposomes (n = 23). After 24h, mice underwent permanent occlusion (PO) or transient ischemia-reperfusion (I/R, 60min) of the left coronary artery or sham surgery. Cardiac inflammation was assessed on MI + 1d, 3d, and 7d by CXCR4-targeted PET/CT using 68Ga-pentixafor. 99mTc-sestamibi SPECT/CT and cardiac magnetic resonance (CMR) calculated infarct sizes and left ventricular (LV) function at 1wk and 6wks. 18F-NaF PET/CT measured tissue microcalcification at 4wks. Imaging signals were validated by ex vivo autoradiography and immunohistochemistry. Results Clodronate macrophage depletion did not affect infarct size compared to PBS, but perfusion defects at 6wks were significantly larger after PO compared to I/R (%LV, 32 ± 11 vs 14 ± 10, p = 0.01). In both models, infarct CXCR4 expression was higher after macrophage depletion vs PBS at all timepoints (%injected dose (ID)/g; d3: PO: 1.4 ± 0.2 vs 0.9 ± 0.1; I/R: 1.4 ± 0.2 vs 1.0 ± 0.02; p &amp;lt; 0.05), and confirmed by ex vivo autoradiography. Immunostaining demonstrated fewer macrophages and higher neutrophil content within the myocardium after macrophage depletion vs PBS at 1d, 3d, and 7d post-MI. Acute LV rupture after PO was more frequent in macrophage-depleted than PBS mice (37% vs 17%). Conversely, surviving PO mice showed a similarly impaired ejection fraction (EF) after macrophage depletion vs PBS at 6wks (%, 32 ± 9 vs 32 ± 11, p = 0.84). No acute LV rupture was observed after I/R, but macrophage depletion led to worse EF (%, 42 ± 11 vs 54 ± 3, p = 0.1). Macrophage-depleted mice exhibited a dense intracavity thrombus adherent to the infarct wall after either injury, as visualized on CMR at 1wk. 18F-NaF PET identified active calcification localized to the thrombus region 4wks after MI, which was colocalized to CT opaque regions at 6wks. Conclusion Macrophage depletion impairs cardiac repair via several mechanisms including neutrophil-dominated inflammation, LV thrombus formation and tissue calcification. This observation underscores the requirement of macrophages for effective healing and may explain adverse response to broad anti-inflammatory therapy in myocardial ischemia.

The incidence of stroke in patients with early echocardiography after acute myocardial infarction.

Left ventricular (LV) thrombus formation after ST-elevation myocardial infarction (STEMI) increases the risk of stroke. In our center, most echocardiograms are performed within 2days post-STEMI. However, LV thrombi often become visible later. We assessed the 1-year incidence of stroke in patients without LV thrombus on echocardiography performed early (1-2days) vs. later (day ≥ 3) post-STEMI. This retrospective observational study included 416 patients with acute STEMI. Patients with atrial fibrillation were excluded. All patients underwent echocardiography during admission. Patients with stroke within 12months post-STEMI were identified from the hospital charts and administrative databases. Most echocardiograms (75%) were performed ≤ 2days post-STEMI. LV thrombus was identified in 12 patients. One (8.3%) patient with LV thrombus and 10 (2.5%) patients without LV thrombus suffered stroke within 12months post-STEMI. Most patients with stroke had apical akinesis. Most strokes occurred during the index admission or within 67days of STEMI. There was no significant difference in the incidence of stroke between the patients with early vs. later echocardiography post-STEMI. The incidence of stroke after STEMI is low and similar between patients with echocardiography performed early vs. later post-STEMI which supports our current clinical practice. Importantly, most strokes occur in patients without LV thrombus on early echocardiography. High reported mortality rate associated with stroke following STEMI justifies the need for further validation in prospective studies to identify patients who may benefit from repeat imaging to detect later LV thrombus formation, and how this will impact patient outcomes and healthcare costs.

Incidence and Predictors of Left Ventricular (LV) Thrombus after ST-Elevation Myocardial Infarction (STEMI) in the Holy Capital of Saudi Arabia.

BackgroundPatients with acute myocardial infarction (AMI) especially those with large MI (myocardial infarction) as identified by ST elevation in multiple contiguous ECG leads or anterior MI, may suffer significant myocardial damage leading to impaired wall motion and contractility which may lead to the formation of left ventricular thrombus (LVT) in the patient. This study was aimed to establish the incidence of LV thrombus and determine the predictors associated with the formation of LV thrombus in patients with AMI.MethodsThis retrospective study was held at the only cardiothoracic centre of Makkah, which provides tertiary level cardiac services. A total of 3084 consecutive patients with acute MI between 2016 and 2019 were identified and divided into two groups i.e. group I (with LVT) and group II (without LVT). The case notes, echocardiography data and cardiac catheterization lab records were reviewed to identify patients with LV thrombus. Regression analysis was employed to evaluate the predictors responsible for the formation of LV thrombus.ResultsThe overall incidence for LV thrombus was determined as 8.4% (n = 260/3084), while in the subpopulation of pilgrims, it was 8.2% (83/1001). Mean age for patients with and without LVT was 54 ± 11 years vs 56 ± 12 years (p < 0.003), respectively. There was no significant difference between the two groups with respect to gender, diabetes, hypertension, smoking, Arabic speaking or BMI>30. Coronary thrombus aspiration was utilized in 17% vs 12% (p < 0.023) patients with LVT and without LVT, respectively. It was observed that the patients with cardiac arrest tend to develop more LVT i.e. 8.5% vs 5.2% (p < 0.033). However, LV thrombus formation was significantly associated with anterior STEMI with incidence of LVT reaching 13.4% and low ejection fraction (all MI types) i-e. 32 ± 9% vs 42 ± 11%, with p < 0.000 for both independent predictors.ConclusionsLV thrombus is a relatively common occurrence in patients with acute MI, especially those with anterior STEMI and low ejection fraction<30%. Appropriate imaging studies are required for all acute MI patients in order to ascertain the presence or absence of LV thrombus as it has major influence on further management.

Related factors of left ventricular thrombus formation within two weeks in patients with acute ST-segment elevation myocardial infarction and left ventricular aneurysm

Objective: To investigate the related factors of left ventricular thrombus (LVT) formation within two weeks in patients with acute ST-segment elevation myocardial infarction (STEMI) and left ventricular aneurysm (LVA). Methods: Consecutive inpatients with acute STEMI and left ventricular aneurysm, hospitalized from January 2014 to June 2020 in the First Affiliated Hospital of Zhengzhou University, were enrolled in this retrospective study. Patients were divided into LVT group and non-LVT group according to the presence or absence of LVT. The clinical data, echocardiography findings, coronary angiography and treatments were compared between the two groups. Subgroup analysis was performed on the patients receiving primary percutaneous coronary intervention (PCI). Onset to door, door to balloon, onset to balloon time were also compared. Multivariate logistic regression was used to analyze the related factors of LVT formation early post STEMI in enrolled patients. The effects of each index in multivariate logistic regression analysis were illustrated in the forest plot. Results: A total of 144 patients were included, there were 52 cases (36.1%) in LVT group, the age was (56.4±11.2) years, and 46 (88.5%) cases were male. There were 92 cases (63.9%) in non-LVT group, the age was (61.7±11.5) years, and there were 73 (79.3%) males in this group. The patients in LVT group were younger than those in non-LVT group, the proportion of anemia, history of heavy drinking, history of chronic kidney disease, left ventricular ejection fraction (LVEF) ≤40%, preoperative thrombosis in myocardial infarction (TIMI) blood flow grade 0 and postoperative TIMI blood flow grade ≤2 were significantly higher in LVT group than those in non-LVT group (all P<0.05). The incidence of history of angina, collateral circulation of the coronary arteries, primary PCI or venous thrombolysis were significantly lower in LVT group than those in non-LVT group (all P<0.05). The percentage of anti-platelet therapy and anticoagulant therapy was similar between the two groups (all P˃0.05). Subgroup analysis in patients undergoing primary PCI showed that onset to door, door to balloon, onset to balloon time were similar between the two groups. Multivariate logistic regression analysis and forest plot showed that history of heavy drinking (OR=6.982, 95%CI 1.501-32.469, P=0.013), anemia (OR=3.373, 95%CI 1.075-10.585, P=0.037), LVEF≤40% (OR=3.016, 95%CI 1.027-8.859, P=0.045), preoperative TIMI blood flow grade 0 (OR=3.311, 95%CI 1.214-9.029, P=0.019) were positively correlated with LVT in patients with acute STEMI and LVA. History of angina (OR=0.159, 95%CI 0.058-0.441, P<0.001), collateral circulation of the coronary arteries (OR=0.189, 95%CI 0.053-0.673, P=0.010), primary PCI or venous thrombolysis (OR=0.252, 95%CI 0.093-0.682, P=0.007) were negatively correlated with LVT in patients with acute STEMI and LVA. Conclusions: History of heavy drinking, anemia, LVEF ≤40%, preoperative TIMI blood flow grade 0 are associated with increased risk of the LVT in patients with acute STEMI and LVA at early stage of the disease. However, history of angina, collateral circulation of the coronary arteries, primary PCI or venous thrombolysis are associated with lower risk of the LVT in these patients.

Left Ventricular Thrombosis in a Case of Acute Inferior Wall Myocardial Infarction

Left ventricular (LV) thrombosis is caused by multiple etiological factors. Acute anterior wall myocardial infarction tops the list. Acute inferior wall infarction is not commonly associated with LV thrombus formation. A rare case of LV thrombus formation at LV apex due to acute inferior wall myocardial infarction is described in a young adult with successful resolution on medical therapy. Appropriate cardiac imaging is the key in correct diagnosis and treatment.

Uncertainties about left ventricular thrombus after STEMI.

Uncertainties remain about the diagnostic and therapeutic strategy to prevent left ventricular thrombus formation after myocardial infarction. In particular, the roles of predisposing factors and prophylactic anticoagulation have not been sufficiently considered. We propose an ‘uncertainties flowchart’ with the aim of stimulating research on the topic.

Left Ventricular Thrombus in Patients with COVID-19 – A Case Series

Scarred culprit vessel territory secondary to nonreperfused myocardial infarctions (MIs), nonischemic cardiomyopathy, left ventricular (LV) noncompaction, endomyocardial fibrosis, and long-standing arrythmias are usually causes of LV thrombus (LVT) formation. However, in the setting of MI, large infarctions, apical akinesia or dyskinesia, LV aneurysms are often predisposed t'o the formation of LVT. The hypercoagulable or inflammatory disorder can rarely predispose to the formation of LVT. In early prethrombolytic and thrombolytic periods, LVT was present in 20%–50% of patients in the context of acute MI, more commonly in acute anterior or apical MI. While the incidence of LVT has dropped in recent times, its identification is expected to rise during the COVID-19 pandemic. Patients with chest pain are more likely to delay initial hospitalization because of a fear of contracting COVID-19. Infection with COVID-19 was associated with the remarkably hypercoagulable state which increased the risk of the early development of LVT in the setting of MI or underlying prethrombotic conditions. We present a series of four cases in which COVID-19 and cardiovascular disease were characterized by various configurations of large LVT.

A review of the oresentation and outcome of left ventricular thrombus in COVID-19 infection

Cardiovascular complications of the Coronarvirus disease (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2), have been documented both in the acute phase and in convalescence. One such complication is the formation of left ventricular (LV) thrombus. Read more JCTRes.com

Chapter 6 - Neurological complications of coronary heart disease and their management

While risk factors for the development of neurovascular and coronary heart disease (CHD) are similar, it is important to consider neurologic complications of CHD separately, as many of these complications are a direct result of the underlying condition or procedures performed to treat atherosclerotic coronary disease. Stroke after myocardial infarction (MI) and acute coronary syndromes (ACSs) is not infrequent, occurring in 0.7%-2.5% of patients within 6 months of the coronary event. The etiology of these events can be frequently traced to the development of left ventricular thrombus (LVT) formation after large MI episodes. Often, however, these events are directly related to catheter-based procedures or anticoagulation strategies utilized to treat the ACS. Ischemic strokes outnumber hemorrhagic strokes in this population. While there is a modest evidence base for use of anticoagulation to treat LVT, catheterization-related ischemic stroke and anticoagulation-related hemorrhagic stroke are typically managed via standard approaches.

Apical Longitudinal Strain Can Help Predict the Development of Left Ventricular Thrombus after Anterior Myocardial Infarction.

Left ventricular (LV) thrombus formation is a common complication of anterior myocardial infarction (ANT-MI). The aim of this study was to investigate the relationship between apical longitudinal strain (ALS) and LV apical thrombus after ANT-MI. The cross-sectional study included a total of 235 patients who were followed up after primary percutaneous coronary intervention performed for ANT-MI and had a reduced LV ejection fraction (LVEF) (< -40%). Of these patients, 24 were excluded from the study, and the remaining 211 patients were included in the analysis. Patients were divided into two groups based on the presence (n = 42) or absence (n = 169) of LV thrombus detected by echocardiography. ALS was measured using speckle-tracking echocardiography. Thrombus was detected in 42 of 211 patients. There was no significant difference between the groups regarding age or gender. Apical strain (AS), global longitudinal strain (GLS), apical wall thickness (AWT), and EF were significantly lower in patients with LV apical thrombus when compared to those without LV apical thrombus (AS, -5.00 +- 2.30% vs. -8.54 +- 2.48%, p < 0.001; GLS, -10.6 +- 3.54% vs. -12.1 +- 2.84%, p = 0.013; AWT, 4.71 +- 1.11 vs. 6.33 +- 1.78 mm, p < 0.001; EF, 31.40 +- 4.10% vs. 37.75 +- 3.17%, p < 0.001). On univariate and multivariate analyses, aneurysm (AA), AS, and AWT were found to be independent predictors of LV apical thrombus (AA, odds ratio [OR] 4.649, p = 0.010; AS, OR 1.749, p < 0.001; AWT, OR 0.729, p = 0.042). ALS is highly sensitive and specific for predicting LV thrombus after ANT-MI. An early and accurate evaluation of LV thrombus may prevent embolic complications, particularly cerebrovascular events.

The prognostic value of Tei index in acute myocardial infarction: a systematic review

Background:Echocardiographic evaluation of left ventricular ejection fraction (LVEF) is used in the risk stratification of patients with an acute myocardial infarction (AMI). However, the prognostic value of the Tei index, an alternative measure of global cardiac function, in AMI patients is not well established.Methods:We conducted a systematic review, using MEDLINE and EMBASE, to evaluate the prognostic value of the Tei index in predicting adverse outcomes in patients presenting with AMI. The data was collected and narratively synthesised.Results:A total of 16 studies were including in this review with 2886 participants (mean age was 60 years from 14 studies, the proportion of male patients 69.8% from 14 studies). Patient follow-up duration ranged from during the AMI hospitalisation stay to 57.8 months. Tei index showed a significant association with heart failure episodes, reinfarction, death and left ventricular thrombus formation in 14 out of the 16 studies. However, in one of these studies, Tei index was only significantly predictive of cardiac events in patients where LVEF was <40%. In two further studies, Tei index was not associated with predicting, adverse outcomes once LVEF, left ventricular end-systolic volume index and left ventricular early filling time was takeninto consideration. In the two remaining studies, there was no prognostic value of Tei index in relation to patient outcomes.Conclusion:Tei index may be an important prognostic marker in AMI patients, however, more studies are needed to better understand when it should be used routinely within clinical practice

Intra-Cardiac Thrombus in COVID-19 pandemic – Case Series and Review

ABSTRACT Various publications have increasingly reported the development of the prothrombotic state and its consequences associated with coronavirus disease 2019 (COVID-19). Although the exact etiology is uncertain, various factors collectively increase the risk of thrombus formation in COVID-19 patients. We present a case series of four patients with left ventricular (LV) thrombus formation along with simultaneous COVID-19 infection. All these patients had acute myocardial infarction with left ventricular ejection fraction (LVEF) between 35-45%. Among the series, two patients had favourable outcomes with complete resolution of LV thrombus, whereas the other two suffered cerebral embolization followed by mortality. This study looks in depth at all cases of intracardiac thrombi formation in patients with COVID-19 published worldwide. n addition to the increased predisposition for venous/ arterial thrombosis, even a few cases of intra- cardiac thrombus have been reported. Systemic thrombolysis is an initial treatment of choice for the management of right cardiac thrombi with pulmonary thromboembolism (PTE) and ST-elevation myocardial infarction (STEMI) in COVID-19. Right cardiac thrombi have better outcomes when compared to left cardiac thrombi.