Left ventricular thrombus incidence and behavior studied by serial two-dimensional echocardiography in acute anterior myocardial infarction: left ventricular wall motion, systemic embolism and oral anticoagulation

Department of Cardiology, Free University Hospital, Amsterdam, The Netherlands.

Serial two-dimensional echocardiography was performed to detect left ventricular thrombus in 92 consecutive patients with a confirmed first acute anterior myocardial infarction. Thirty left ventricular thrombi were diagnosed in these 92 patients. The cumulative percent of identified thrombus in each echocardiographic examination in the surviving patients was 27% at less than 24 h; 57% at 48 to 72 h; 75% at 1 week and 96% at 2 weeks. The thrombus shape was defined as mural in 53% and protruding in 47% of patients. Systemic embolism (stroke) was noted during hospitalization in two patients with a protruding thrombus. At 12 weeks of follow-up, patients with thrombus had poorer (and almost unchanged from baseline) global left ventricular function as expressed by wall motion score compared with that of patients without thrombus, who exhibited significant improvement. Global left ventricular wall motion in patients with persisting or resolved thrombus was similar during follow-up. Apical wall motion worsened in 70% of the patients with persisting thrombus and in 25% of the patients with resolved thrombus (p less than 0.1). In the 22 surviving patients with thrombus, resolution or change in thrombus shape or size was noted in 14 of the 15 patients receiving anticoagulant therapy and in 4 of the 7 untreated patients. Six of the 18 patients with an early- (48 to 72 h) and none of the 12 patients with a later-formed thrombus died. Maximal serum enzyme levels, percent with Killip functional class III to IV and left ventricular wall motion score were higher in the patients with an early- than in those with a later-formed thrombus.(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				S Sen, S Laowatana, J Lima, and S M Oppenheimer Risk factors for intracardiac thrombus in patients with recent ischaemic cerebrovascular events J. Neurol. Neurosurg. Psychiatry, October 1, 2004; 75(10): 1421 - 1425. [Abstract] [Full Text] [PDF]

				S. Sen, S. M. Oppenheimer, J. Lima, and B. Cohen Risk Factors for Progression of Aortic Atheroma in Stroke and Transient Ischemic Attack Patients Stroke, April 1, 2002; 33(4): 930 - 935. [Abstract] [Full Text] [PDF]

				S. E WIEGERS and M. S. J. SUTTON When should ACE inhibitors or warfarin be discontinued after myocardial infarction? Heart, October 1, 2000; 84(4): 361 - 362. [Full Text]

				M. K. Kapral and F. L. Silver Preventive health care, 1999 update: 2. Echocardiography for the detection of a cardiac source of embolus in patients with stroke Can. Med. Assoc. J., October 19, 1999; 161(8): 989 - 996. [Abstract] [Full Text] [PDF]

				L. J. Collins, D. I. Silverman, P. S. Douglas, and W. J. Manning Cardioversion of Nonrheumatic Atrial Fibrillation : Reduced Thromboembolic Complications With 4 Weeks of Precardioversion Anticoagulation Are Related to Atrial Thrombus Resolution Circulation, July 15, 1995; 92(2): 160 - 163. [Abstract] [Full Text]

				R. L. Wilensky and S. C. Jung Thromboembolism in Patients with Decreased Left Ventricular Function: Incidence, Risk, and Treatment European Journal of Cardiovascular Prevention & Rehabilitation, April 1, 1995; 2(2): 91 - 96. [Abstract] [PDF]