Key result
16-segment apical wall motion score predicts ~68% higher odds of TTE-occult LVT after acute STEMI.
Why the study?
Patients with acute STEMI are at significant risk for LV thrombi, but this complication often remains undetected by TTE.
Does the 16-segment apical wall motion score (AWMS16Seg) predict the presence of TTE-occult left ventricular thrombi in patients with acute STEMI?
Observational (n=870)
Does the 16-segment apical wall motion score (AWMS16Seg) predict the presence of TTE-occult left ventricular thrombi in patients with acute STEMI?
Odds Ratio: 1.68 (95% CI 1.43–1.97)
p-value: p=<0.001
An AWMS16Seg score ≥ 8 on echocardiography is a highly sensitive predictor of occult left ventricular thrombi after STEMI, identifying patients who would benefit from CMR imaging.
AIM: The aim of this study was to investigate predictors of transthoracic echocardiography (TTE)-occult left ventricular (LV) thrombi (LVT) and to propose a clinical model for improved detection of TTE-occult LVT post-ST-elevation myocardial infarction (STEMI). Patients with acute STEMI are at significant risk for developing LVT. However, this complication often (up to 65%) remains undetected by using TTE, referred to as TTE-occult LVT. METHODS AND RESULTS: In total, 870 STEMI patients underwent TTE and cardiac magnetic resonance (CMR), the reference method for LVT detection, 3 days after infarction. Clinical (body mass index, peak cardiac troponin T) and echocardiographic [ejection fraction, apical wall motion scores (AWMSs)] predictors were analysed. Primary endpoint was the presence of TTE-occult LVT identified by CMR imaging. From the overall cohort, 37 patients (4%) showed an LVT by CMR. Of these thrombi, 25 (68%) were not identified by TTE. Transthoracic echocardiography-occult thrombi did not significantly differ in volume (1.4 vs. 2.74 cm3), diameter (19.0 vs. 23.3 mm), and number of fragments or shape compared with TTE-apparent LVT (all P > 0.05). For predicting these TTE-occult LVT, the 16-segment AWMS (AWMS16Seg) showed highest validity {area under the curve: 0.91 [95% confidence interval (CI): 0.89-0.93]; P < 0.001}, with an association independent of ejection fraction and 17-segment AWMS (AWMS17Seg) [odds ratio: 1.68 (95% CI: 1.43-1.97); P < 0.001] and clinical (body mass index, peak troponin) and angiographic (culprit lesion, post-interventional thrombolysis in myocardial infarction flow) associates of TTE-occult LVT (all P < 0.05). Dichotomization at AWMS16Seg ≥ 8 (n = 260, 30%) allowed for a detection of all TTE-occult LVT (sensitivity: 100%), with a corresponding specificity of 77%. CONCLUSION: After acute STEMI, AWMS16Seg served as a simple and very robust predictor of TTE-occult LVT. An AWMS16Seg-based algorithm to identify patients for additional CMR imaging offers great potential to optimize detection of TTE-occult LVT following STEMI.
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Reindl et al. (2023) conducted an observational in ST-elevation myocardial infarction (n=870). 16-segment apical wall motion score (AWMS16Seg) was evaluated on presence of TTE-occult LVT identified by CMR imaging (OR 1.68, 95% CI 1.43-1.97, p=<0.001). The 16-segment apical wall motion score independently predicted TTE-occult left ventricular thrombi after acute STEMI (OR 1.68; 95% CI 1.43-1.97; P<0.001).
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