Prediction of left ventricular thrombus after myocardial infarction: a cardiac magnetic resonance-based prospective registry

Abstract

Cardiac magnetic resonance; Left ventricular thrombus; ST-segment elevation myocardial infarction

Resonancia magnética cardiaca; Trombo ventricular izquierdo; Infarto agudo de miocardio con elevación del segmento ST

Ressonància magnètica cardíaca; Trombe ventricular esquerre; Infart de miocardi amb elevació del segment ST

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.

This work was supported by Instituto de Salud Carlos III, Fondos Europeos de Desarrollo Regional FEDER and Fondo Social Europeo Plus (FSE+) (grant numbers PI20/00637, PI23/01150, CIBERCV16/11/00486, CIBERCV16/11/00420, CIBERCV16/11/00479, CIBERCV16/11/00292 and postgraduate contracts CM21/00175, CM23/00246 and CM23/00238) and by Conselleria de Innovación, Universidades, Ciencia y Sociedad Digital of the Generalitat Valenciana (PROMETEO/2021/008). Dr. Marcos-Garcés acknowledges funding from the Instituto de Salud Carlos III and co-funding from Fondo Social Europeo Plus (FSE+) (grant JR23/00032), as well as a GE 2023 grant from the Conselleria de Innovación, Universidades, Ciencia y Sociedad Digital of the Generalitat Valenciana (CIGE/2022/26). Dr. Gavara has received financial support from the Agencia Estatal de Investigación (grant FJC2020–043981-I/AEI/10.13039/501100011033). Dr. Moratal has received financial support from the Conselleria d'Educació, Investigació, Cultura i Esport, Generalitat Valenciana (grants AEST/2019/037 and AEST/2020/029).