Incidence and Natural History of Left Ventricular Thrombus Following Anterior Wall Acute Myocardial Infarction

doi:10.1016/S0002-9149(97)00392-5

The American Journal of Cardiology

Volume 80, Issue 4, 15 August 1997, Pages 442-448

https://doi.org/10.1016/S0002-9149(97)00392-5 Get rights and content

Abstract

Previous studies have reported left ventricular (LV) thrombus in 20% to 56% of patients after anterior wall acute myocardial infarction (AMI). The Healing and Early Afterload Reducing Therapy (HEART) study was a prospective study comparing effects of early (24 hours) or delayed (14 days) initiation of ramipril, an angiotensin-converting enzyme inhibitor, on LV function after anterior wall AMI. This ancillary study assessed prevalence of LV thrombus. Two-dimensional echocardiography was performed on days 1, 14, and 90 after myocardial infarction. The cohort consisted of 309 patients. Q-wave anterior wall AMI occurred in 78%; 87% received reperfusion therapy. The prevalence of LV thrombus was 2 of 309 (0.6%) at day 1, 11 of 295 (3.7%) at day 14, and 7 of 283 (2.5%) at day 90. One patient had thrombus at 2 examinations. The day 1 echocardiogram was not correlated with thrombus development. LV size increased more in patients with thrombus than in those without thrombus. Patients with thrombus had more wall motion abnormality after day 1 than patients without thrombus (p = 0.03). Thus, the current prevalence of LV thrombus in anterior wall AMI is lower than previously reported, possibly due to changes in AMI management. Preservation of LV function is likely to be an important mechanism. Most thrombi are seen by 2 weeks after AMI. Resolution documented by echocardiography is frequent.

Section snippets

Patient Selection

Inclusion criteria for HEART were age >21, presentation consistent with AMI and ST-segment elevation >1 mm in ≥2 contiguous anterior leads with new pathologic Q waves. Exclusion criteria were absolute or relative contraindications to angiotensin-converting enzyme inhibitors, patients already requiring angiotensin-converting enzyme inhibitor therapy for heart failure, and complicated AMI not stabilized within 24 hours, including ongoing ischemia, unstable rhythm, and systolic arterial pressure

Results

Of the 352 patients randomized, there were 317 patients with adequate baseline echocardiograms and 309 patients in whom all echocardiograms were adequate for quantitative analysis and evaluation of LV thrombus.

Discussion

The cumulative prevalence of LV thrombus at day 90 in this study was 6.4%. Although a historical control with a similar degree of LV dysfunction is not available, this rate is lower than that reported in other series,3, 6, 8, 18, 19 despite anterior wall AMI. There are a number of possible explanations for the discrepancy. The HEART study excluded patients with severe hypotension and heart failure requiring angiotensin-converting enzyme inhibitor treatment, clinical characteristics associated

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^fn1: This study was supported by an investigator-initiated grant from Hoechst Marion Roussel formerly Hoechst Roussel Pharmaceuticals, Inc. (Somerville, New Jersey) and the Upjohn Company (Kalamazoo, Michigan).

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flaIncidence and Natural History of Left Ventricular Thrombus Following Anterior Wall Acute Myocardial Infarctionfn1

Abstract

Section snippets

Patient Selection

Results

Discussion

J Am Coll Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Int J Cardiol

Am J Cardiol

Am J Cardiol

J Am Coll Cardiol

Chest

Am J Cardiol

Lancet

Spontaneous morphologic changes in left ventricular thrombus: a prospective two-dimensional echocardiographic study

Circulation

Effect of early anticoagulation on the frequency of left ventricular thrombi after anterior wall acute myocardial infarction

Am J Cardiol

fla
Incidence and Natural History of Left Ventricular Thrombus Following Anterior Wall Acute Myocardial Infarctionfn1