Determination of the prevalence and predictors of ventricular thrombus with assessment of the risk of systemic embolization to the CNS in patients after acute myocardial infarction using magnetic resonance imaging, echocardiography and cardiac markers - a prospective, unicentric, observational study.

IF 0.7 4区 医学 Q4 MEDICINE, RESEARCH & EXPERIMENTAL
Biomedical Papers-Olomouc Pub Date : 2025-06-01 Epub Date: 2023-01-08 DOI:10.5507/bp.2023.050
Stepan Hudec, Martin Hutyra, Jan Precek, Jan Latal, Radomir Nykl, Miloslav Spacek, Martin Sluka, Daniel Sanak, Zbynek Tudos, Dalibor Pastucha, Milos Taborsky
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引用次数: 0

Abstract

Background: Left ventricular thrombus (LVT) formation is one of the well-known and serious complications of acute myocardial infarction (AMI) due to the risk of systemic arterial embolization (SE). To diagnose LVT, echocardiography (TTE) is used. Late gadolinium-enhanced cardiovascular magnetic resonance (DE-CMR) is the gold standard for diagnosing LVT.

Objectives: The aim of this observational study was to determine the role of transthoracic echocardiography and cardiac markers in predicting the occurrence of LVT compared with a reference cardiac imaging (DE-CMR) and to determine the risk of systemic embolization to the CNS using brain MRA.

Methods: Seventy patients after MI managed by percutaneous coronary intervention (localization: 92.9% anterior wall, 7% other; median age 58.7 years) were initially examined by transthoracic echocardiography (TTE, n=69) with a focus on LVT detection. Patients were then referred for DE-CMR (n=55). Laboratory determination of cardiac markers (Troponin T and NTproBNP) was carried out in all. Brain MRA was performed 1 year apart (n=51).

Results: The prevalence of LVT detected by echocardiography: (n=11/69, i.e. 15.9%); by DE-CMR: (n=9/55, i.e. 16.7%). Statistically significant parameters to predict the occurrence of LVT after AMI (cut off value): (a) detected by echocardiography: anamnestic data - delay (≥ 5 hours), echocardiographic parameters - left atrial volume index (LAVI≥ 32 mL/m2), LV EF Simpson biplane and estimated (≤ 42%), tissue Doppler determination of septal A wave velocity (≤ 7.5cm/s); (b) detected by DE-CMR: anamnestic data - delay (≥ 13 hours), DE-CMR parameters - left ventricular end-diastolic diameter (≥ 54mm). The value of cardiac markers (Troponin T and NTproBNP in ng/L) in LVT detected by echocardiography did not reach statistical significance. In LVT detected by DE-CMR, NTproBNP was statistically significantly increased at 1 month after AMI onset (no optimal cut-off value could be determined). There was no statistically significant association between the LVT detection (both modalities) and the occurrence of clinically manifest and silent cardioembolic events.

Conclusion: Our study confirmed a relatively high prevalence of LVT in the high-risk group of patients with anterior wall STEMI. Due to the low prevalence of thromboembolic complications, no significant association between the LVT detection and the occurrence of a cardioembolic event was demonstrated.

利用磁共振成像、超声心动图和心脏标记物确定急性心肌梗死后患者心室血栓的发生率和预测因素,并评估中枢神经系统发生系统性栓塞的风险--一项前瞻性、单中心观察研究。
背景:左心室血栓(LVT)的形成是急性心肌梗死(AMI)众所周知的严重并发症之一,因为它有全身动脉栓塞(SE)的风险。诊断 LVT 需要使用超声心动图(TTE)。晚期钆增强心血管磁共振(DE-CMR)是诊断 LVT 的金标准:本观察性研究旨在确定经胸超声心动图和心脏标记物与参考心脏成像(DE-CMR)相比在预测 LVT 发生方面的作用,并利用脑 MRA 确定中枢神经系统发生全身性栓塞的风险:70名经皮冠状动脉介入治疗的心肌梗死患者(定位:92.9%为前壁,7%为其他部位;中位年龄58.7岁)首先接受了经胸超声心动图(TTE,69人)检查,重点是LVT检测。随后,患者被转诊至 DE-CMR(55 人)。所有患者均进行了心脏标志物(肌钙蛋白 T 和 NTproBNP)的实验室检测。相隔1年进行脑部MRA检查(51人):结果:超声心动图检测出的左心室室间隔缺损发生率为(n=11/69,即15.9%);DE-CMR检测出的左心室室间隔缺损发生率为(n=9/55,即16.7%)。预测急性心肌梗死后 LVT 发生的有统计学意义的参数(截断值):(a) 通过超声心动图检测:病史数据--延迟(≥ 5 小时),超声心动图参数--左房容积指数(LAVI≥ 32 mL/m2),左心室 EF 辛普森双平面和估计值(≤ 42%),组织多普勒测定室间隔 A 波速度(≤ 7.5cm/s);(b)通过 DE-CMR 检测:异常数据--延迟(≥ 13 小时),DE-CMR 参数--左心室舒张末期直径(≥ 54 毫米)。在超声心动图检测到的左心室舒张功能障碍中,心脏标志物(肌钙蛋白 T 和 NTproBNP,单位为 ng/L)的价值未达到统计学意义。在通过 DE-CMR 检测到的 LVT 中,NTproBNP 在急性心肌梗死发生后 1 个月显著增加(无法确定最佳临界值)。LVT检测(两种方式)与临床表现和无声心肌栓塞事件的发生之间没有统计学意义上的明显联系:我们的研究证实,在前壁 STEMI 患者的高危人群中,LVT 的发病率相对较高。由于血栓栓塞并发症的发生率较低,因此 LVT 检测与心血管栓塞事件的发生之间并无明显关联。
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来源期刊
Biomedical Papers-Olomouc
Biomedical Papers-Olomouc MEDICINE, RESEARCH & EXPERIMENTAL-
CiteScore
2.30
自引率
0.00%
发文量
74
审稿时长
6-12 weeks
期刊介绍: Biomedical Papers is a journal of Palacký University Olomouc, Faculty of Medicine and Dentistry, Olomouc, Czech Republic. It includes reviews and original articles reporting on basic and clinical research in medicine. Biomedical Papers is published as one volume per year in four issues.
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