Prediction of late left ventricular thrombus formation after ST-elevation myocardial infarction: A cardiovascular magnetic resonance study

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2025-07-19 DOI:10.1016/j.ijcha.2025.101753

Magdalena Holzknecht , Christina Tiller , Ivan Lechner , Fritz Oberhollenzer , Alex Kaser , Martin Reindl , Felix Troger , Mathias Pamminger , Axel Bauer , Bernhard Metzler , Sebastian Johannes Reinstadler , Agnes Mayr

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引用次数: 0

Abstract

Background

Little is known about the prevalence of late left ventricular thrombus (LVT) formation after ST-elevation myocardial infarction (STEMI). Compared with transthoracic echocardiography (TTE), cardiovascular magnetic resonance (CMR) imaging has a much higher sensitivity for LVT detection in patients after acute STEMI. However, routine CMR imaging is currently not integrated in post-STEMI management. We sought to develop a practical risk score for the prediction of late LVT formation after STEMI.

Methods and Results

Six hundred and nine patients with STEMI underwent CMR at 3 [IQR:2–4] days and 4.4 [IQR:4.1–4.9] months after primary percutaneous coronary intervention (PCI) for acute STEMI. A LVT was visualized in 37 patients (6.1 %) at baseline CMR and was newly diagnosed in 10 patients (1.6 %) at 4 months follow-up (4FU) CMR and in 4 patients (0.7 %, 60 % false-negative rate of TTE in detecting LVT) by 4FU TTE. A simple clinical risk score including associates of late LVT (left anterior descending artery as culprit vessel and 4FU NT-pro-BNP > 236 ng/l), with a range of 0 to 2 points (median risk score: 1 point) showed a strong and significantly higher area under the curve (0.89, 95 %CI 0.86–0.91; p < 0.001) for LVT prediction at 4FU than each individual risk factor alone (p < 0.001). The sensitivity and specificity of the risk score were 100 % and 77 %, respectively.

Conclusions

The proposed risk score may offer preliminary utility in predicting late LVT and could help to identify patients with STEMI in whom CMR for late LVT assessment might be particularly informative. Additional investigation in larger cohorts is warranted to validate the clinical application of the score.

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st段抬高型心肌梗死后晚期左室血栓形成的预测：心血管磁共振研究

背景st段抬高型心肌梗死（STEMI）后晚期左室血栓（LVT）形成的患病率知之甚少。与经胸超声心动图（TTE）相比，心血管磁共振（CMR）对急性STEMI患者LVT的检测灵敏度要高得多。然而，常规CMR成像目前尚未整合到stemi后的治疗中。我们试图开发一个实用的风险评分来预测STEMI后晚期LVT的形成。方法与结果669例STEMI患者分别于急性STEMI经皮冠状动脉介入治疗（PCI）后3 [IQR: 2-4]天和4.4 [IQR: 4.1-4.9]个月行CMR。37例患者（6.1%）在基线CMR时可见LVT， 10例患者（1.6%）在4个月随访（4FU） CMR时被新诊断，4例患者（0.7%，LVT假阴性率60%）通过4FU TTE检测。一个简单的临床风险评分包括晚期LVT（左前降支为罪魁祸首血管）和4FU NT-pro-BNP >；236 ng/l)，在0 ~ 2分（中位风险评分：1分）范围内，曲线下面积明显增大(0.89,95% CI 0.86-0.91；p & lt;0.001)的LVT预测比单独的每个风险因素(p <；0.001)。风险评分的敏感性为100%，特异性为77%。结论提出的风险评分可能在预测晚期LVT方面提供初步效用，并有助于识别STEMI患者，其中CMR对晚期LVT评估可能特别有用。在更大的队列中进行额外的调查是必要的，以验证该评分的临床应用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.