Sequential cardiac MR imaging detected LV thrombus in 7% of STEMI patients, with simultaneous anterior infarction and LVEF <50% conferring the highest risk (20% incidence; P<0.001 for trend).
Cohort (n=392)
What is the incidence, outcome, and predictors of left ventricular thrombus after reperfused STEMI when assessed by sequential cardiac MR imaging?
Sequential cardiac MR imaging after STEMI demonstrates a 7% incidence of LV thrombus, identifies anterior infarction and LVEF <50% as the highest risk factors, and shows that MRI-guided anticoagulation is associated with very low rates of thromboembolism and bleeding.
Purpose To characterize the incidence, outcomes, and predictors of left ventricular (LV) thrombus by using sequential cardiac magnetic resonance (MR) imaging after ST-segment–elevation myocardial infarction (STEMI). Materials and Methods Written informed consent was obtained from all patients, and the study protocol was approved by the committee on human research. In a cohort of 772 patients with STEMI, 392 (mean age, 58 years; range, 24–89 years) were retrospectively selected who were studied with cardiac MR imaging at 1 week and 6 months. Cardiac MR imaging guided the initiation and withdrawal of anticoagulants. Patients with LV thrombus at 6 months were restudied at 1 year. For predicting the occurrence of LV thrombus, a multiple regression model was applied. Results LV thrombus was detected in 27 of 392 patients (7%): 18 (5%) at 1 week and nine (2%) at 6 months. LV thrombus resolved in 22 of 25 patients (88%) restudied within the first year. During a mean follow-up of 181 weeks ± 168, patients with LV thrombus displayed a very low rate of stroke (0%), peripheral embolism (0%), and severe hemorrhage (n = 1, 3.7%). LV ejection fraction (LVEF) less than 50% (P < .001) and anterior infarction (P = .008) independently helped predict LV thrombus. The incidence of LV thrombus was as follows: (a) nonanterior infarction, LVEF 50% or greater (one of 135, 1%); (b) nonanterior infarction, LVEF less than 50% (one of 50, 2%); (c) anterior infarction, LVEF 50% or greater (two of 92, 2%); and (d) anterior infarction, LVEF less than 50% (23 of 115, 20%) (P < .001 for the trend). Conclusion Cardiac MR imaging contributes information for the diagnosis and therapy of LV thrombus after STEMI. Patients with simultaneous anterior infarction and LVEF less than 50% are at highest risk. © RSNA, 2017 Online supplemental material is available for this article.
Cambronero‐Cortinas et al. (Thu,) conducted a cohort in ST-segment-elevation myocardial infarction (STEMI) (n=392). Sequential cardiac MR imaging was evaluated on Incidence of left ventricular (LV) thrombus. Sequential cardiac MR imaging detected LV thrombus in 7% of STEMI patients, with simultaneous anterior infarction and LVEF <50% conferring the highest risk (20% incidence; P<0.001 for trend).