Predictors of left ventricular thrombus formation and delayed resolution in post-acute myocardial infarction and severe left ventricular dysfunction

Background: The predictors of left ventricular thrombus (LVT) formation and resolution, post-acute myocardial infarction (MI), and left ventricular (LV) dysfunction significantly impact management strategies and need updating to reflect contemporary practice. Methods: Transthoracic echocardiography was used to screen and assess post-acute MI patients with LV ejection fraction (LVEF) <35% or <40% with apical akinesis or dyskinesis. Results: We enrolled 979 patients. Of them, 67 (6.84%) patients had an LVT at the baseline. Additionally, 22 and 7 patients developed new LVT at 1 and 3 months. The predictors of LVT formation were the presence of LV aneurysm (HR: 1.45, 95% CI: 1.11-2.07, P=0.024), apical wall motion score index (WMSI) (HR: 1.36, 95% CI: 1.07-2.82, P=0.036), late presentation after MI (HR: 1.32, 95% CI: 1.16-3.16, P=0.042), older age (HR: 1.24, 95% CI: 1.08-3.36, P=0.043), lower baseline LVEF (HR: 1.23, 95% CI: 1.06-2.75, P=0.046) and higher level of low-density lipoprotein-cholesterol (LDL-C) (HR: 1.18, 95% CI: 1.02-2.54, P=0.049). The LVT was resolved in 40 (59.7%) and 32 patients (65.3%) at 1 and 3 months, respectively. The predictors of LVT persistence beyond 3 months were LV aneurysm (HR: 1.55, 95% CI: 1.03-1.87, P=0.024), LVT size at baseline (HR: 1.43, 95% CI: 1.32-2.74, P=0.031), apical WMSI (HR: 1.43, 95% CI: 1.32-2.74, P=0.031), lower LVEF (HR: 1.29, 95% CI: 1.02-2.54, P=0.043) and late presentation after MI (HR: 1.18, 95% CI: 1.07-2.16, P=0.047). Conclusions: The global and apical LV systolic dysfunction, older age, late presentation, and high LDL-C predict LVT formation post-MI. These factors and LVT size predict LVT persistence beyond 3 months. These findings should guide anticoagulation therapy in this high-risk population.