Prediction of left ventricular thrombus after myocardial infarction: a cardiac magnetic resonance-based prospective registry
Por:
Bertolin-Boronat, C, Marcos-Garcés, V, Merenciano-González, H, Perez, N, del Villar, CP, Gavara, J, Lopez-Lereu, MP, Monmeneu, JV, Flores, CH, Domenech-Ximenos, B, López-Fornás, FJ, Rios-Navarro, C, de Dios, E, Moratal, D, Ortiz-Pérez, JT, Bayes-Genis, A, Rodríguez-Palomares, JF, Nuñez, J, Sánchez, PL, Sanchis, J and Bodi, V
Publicada:
1 ene 2025
Ahead of Print:
1 ene 2025
Resumen:
Background: Left ventricular thrombus (LVTh) is a severe complication after ST-segment elevation myocardial infarction (STEMI). Objectives: We aim to predict LVTh occurrence by cardiac magnetic resonance (CMR) using clinical, echocardiographic, and electrocardiographic (ECG) variables readily available at admission. Methods: We included 590 reperfused STEMI patients who underwent early (1-week) and/or late (6-month) CMR in our institution. Baseline clinical, echocardiographic (left ventricular ejection fraction -LVEF-) and ECG data (summatory of ST-segment elevation -sum-STE- and Q-wave and residual ST-elevation >1 mm -Q-STE-) during admission were registered. Multivariate binary logistic regression models and receiver operating characteristic curves were computed for LVTh prediction. Results: LVTh was detected by CMR in 43 (7.3 %) patients and was predicted by previous chronic coronary syndrome (CCS, HR 4.74 [1.82-12.35], p = 0.001), anterior STEMI (HR 10.93 [2.47-48.31], p = 0.002), LVEF (HR 0.96 [0.93-0.99] per %, p = 0.008), maximum sum-STE (HR 1.04 [1.01-1.07] per mm, p = 0.04), and Q-STE (HR 1.31 [1.08-1.6] per lead, p = 0.008). High-risk patients with both major (anterior STEMI and Q-STE in >= 1 leads) and 1-3 minor (CCS, maximum sum-STE >10 mm, LVEF <50%) factors showed the highest LVTh risk (19.6 % within 6 months). The model showed excellent discrimination ability (area under the curve=0.85 [0.81-0.9], p < 0.001). Simplified 4-variable (excluding sum-STE) and 3-variable (also excluding CCS) risk scores showed similar discrimination ability and were externally validated. Conclusions: LVTh within 6 months post-STEMI can be predicted using pre-discharge clinical (anterior infarction and CCS), echocardiographic (LVEF), and ECG (sum-STE and Q-STE) data. Our results can help select patients who should undergo CMR after STEMI for LVTh detection.
Filiaciones:
Bertolin-Boronat, C:
Hosp Clin Univ Valencia, Dept Cardiol, Valencia, Spain
INCLIVA Biomed Res Inst, Valencia, Spain
Univ Salamanca, Fac Med, Salamanca, Spain
Perez, N:
INCLIVA Biomed Res Inst, Valencia, Spain
Ctr Invest Biomed Red Enfermedades Cardiovasc CIBE, Madrid, Spain
Gavara, J:
INCLIVA Biomed Res Inst, Valencia, Spain
Ctr Invest Biomed Red Enfermedades Cardiovasc CIBE, Madrid, Spain
Univ Politecn Valencia, Bldg Technol Res Ctr, Valencia 46022, Spain
Lopez-Lereu, MP:
ASCIRES Biomed Grp, Cardiovasc Magnet Resonance Unit, Valencia, Spain
Monmeneu, JV:
ASCIRES Biomed Grp, Cardiovasc Magnet Resonance Unit, Valencia, Spain
Flores, CH:
Ctr Invest Biomed Red Enfermedades Cardiovasc CIBE, Madrid, Spain
Univ Hosp Salamanca, Dept Cardiol, Salamanca, Spain
Inst Biomed Res Salamanca IBSAL, Salamanca, Spain
Domenech-Ximenos, B:
Inst Invest Biomed August Pi & Sunyer IDIBAPS, Barcelona, Spain
Hosp Clin Barcelona, Cardiothorac Imaging Diagnost Imaging Ctr, Barcelona, Spain
Rios-Navarro, C:
INCLIVA Biomed Res Inst, Valencia, Spain
Ctr Invest Biomed Red Enfermedades Cardiovasc CIBE, Madrid, Spain
Univ Valencia, Fac Med & Odontol, Valencia, Spain
de Dios, E:
Ctr Invest Biomed Red Enfermedades Cardiovasc CIBE, Madrid, Spain
Moratal, D:
Univ Politecn Valencia, Bldg Technol Res Ctr, Valencia 46022, Spain
Ortiz-Pérez, JT:
Hosp Clin Barcelona, Cardiovasc Inst, Barcelona, Spain
:
Ctr Invest Biomed Red Enfermedades Cardiovasc CIBE, Madrid, Spain
Hosp Badalona Germans Trias & Pujol, Cardiol Dept, Badalona, Spain
Hosp Badalona Germans Trias & Pujol, Heart Failure Unit, Badalona, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Rodríguez-Palomares, JF:
Ctr Invest Biomed Red Enfermedades Cardiovasc CIBE, Madrid, Spain
Univ Autonoma Barcelona, Dept Med, Barcelona, Spain
Hosp Univ Vall dHebron, Serv Neonatol, Barcelona, Spain
Vall dHebron Inst Recerca, Barcelona, Spain
Nuñez, J:
Hosp Clin Univ Valencia, Dept Cardiol, Valencia, Spain
INCLIVA Biomed Res Inst, Valencia, Spain
Ctr Invest Biomed Red Enfermedades Cardiovasc CIBE, Madrid, Spain
Univ Valencia, Fac Med & Odontol, Valencia, Spain
Sanchis, J:
Hosp Clin Univ Valencia, Dept Cardiol, Valencia, Spain
INCLIVA Biomed Res Inst, Valencia, Spain
Ctr Invest Biomed Red Enfermedades Cardiovasc CIBE, Madrid, Spain
Univ Valencia, Fac Med & Odontol, Valencia, Spain
Bodi, V:
Hosp Clin Univ Valencia, Dept Cardiol, Valencia, Spain
INCLIVA Biomed Res Inst, Valencia, Spain
Ctr Invest Biomed Red Enfermedades Cardiovasc CIBE, Madrid, Spain
Univ Valencia, Fac Med & Odontol, Valencia, Spain
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