Clinical and speckle tracking echocardiographic predictors of left ventricular thrombus following primary percutaneous coronary intervention for anterior ST-elevation myocardial infarction.

Abstract

Background: Left ventricular thrombus (LVT) remains a serious complication of acute ST-elevation myocardial infarction (STEMI), mandating timely detection and proper antithrombotic therapy. This study aimed to assess the incidence and possible clinical and echocardiographic predictors of LVT development.

Methods: This study prospectively included 300 patients with acute anterior STEMI who underwent primary percutaneous coronary intervention (PPCI). Serial echocardiographic examinations were performed at three time-points post-PPCI: in-hospital, 2-weeks, and 3-months to assess LVT development. LV global (GLS) and regional longitudinal strain (LS) and radial strain were determined. The occurrence of major adverse cardiovascular events (MACE) at three months post-PPCI was reported.

Results: The incidence of LVT development was 16.3 %, most of which (51 %) were detected early at the post-PPCI in-hospital echocardiography examination, whereas 22.4 % were detected at 2 weeks and 26.5 % after 3 months post-PPCI. Prior infarction, longer total ischemic time, no or partial ST-segment resolution, and high coronary thrombus grade were significant independent predictors of LVT development. On receiver operating characteristic analysis, baseline GLS ≥ -11.08 % [area under the curve (AUC) = 0.73, 95 % confidence interval (CI) = 0.65-0.81, p < 0.001] and apical LS ≥ -4.9 % (AUC = 0.75, 95 % CI = 0.69-0.82, p < 0.001) showed significant discrimination for LVT. Adjusted for other covariates, impaired baseline apical LS was the only echocardiographic independent predictor of later LVT development at 2 weeks and 3 months post-PPCI. MACE were significantly higher among patients who developed LVT. LVT resolution was achieved in 93.3 % after three months of anticoagulation.

Conclusion: Serial echocardiographic studies after acute anterior STEMI improved LVT detection. The occurrence of LVT within three months following PPCI was associated with impaired GLS and apical LS obtained after PPCI.