The role of mitral annular plane systolic excursion on left ventricular thrombus formation

Introduction: Dilated cardiomyopathy is associated by radial and longitudinal contractile cardiac dysfunction. LV thrombus is a frequent finding in patients with dilated cardiomyopathy. The main purpose of our study was to evaluate the role of mitral annular plane systolic excursion (MAPSE) in LV thrombus formation in patients with dilated cardiomyopathy. Our additional objective was to compare the role of average MAPSE to other LV features [LV size, LV ejection fraction (EF), wall motion score index (WMSI), sphericity index (w/l)] in LV thrombus development. Methods: This was a prospective cross-sectional study conducted from October 2009 until January 2012 in 100 sinus rhythm patients with dilated cardiomyopathy without anticoagulation therapy. We excluded patients with: swallowing problems, acute myocardial infarction, atrial fibrillation/flatter, severe systolic dysfunction and/or mechanical valves. Results: Mean patient age was 58.1 ± 12.7 years and 69% were men. Mean LV EF was 39.1 ± 6.4%, while mean value of average MAPSE was 9.3 ± 2.2 mm. LV thrombus was detected in 14% of patients and its presence correlated well with: average MAPSE (r=-0.22, p=0.01), MAPSE of sepatal wall (r=-0.23, p=0.01), MAPSE of lateral wall (r=-0.2, p=0.02), MAPSE of inferior wall (r=-0.22, p=0.01), LV EF (r=-0.21, p=0.02), LV end diastolic diameter (r=0.24, p=0.008), LV end systolic diameter (r=0.31, p=0.0008), WMSI (r=0.22, p=0.01) and w/l (r=0.19, p=0.03). Conclusions: Longitudinal LV dysfunction is associated with LV thrombus formation, as average MAPSE demonstrates a negative correlation with LV thrombus, and its role is similar to LV size, LV EF, sphericity index and WMSI.