Tóth Csaba, Ujhelyi Erzsébet, Fülöp Tibor, Istvan Edes
Department of Cardiology, Markhot Ferenc Hospital, Eger, Hungary.
Acta Cardiol. 2002 Jun;57(3):205-11. doi: 10.2143/AC.57.3.2005390.
Clinical epidemiological and echocardiographic risk factors relating to the development of a left ventricular thrombus were studied retrospectively in patients with acute myocardial infarction.
The data on 1833 consecutive patients treated for acute myocardial infarction during a 10-year period were processed retrospectively. Transthoracic echocardiography was performed on each patient 65.0 +/- 5.5 hours after hospital admission. A left ventricular thrombus was detected in 145 patients (7.9%). The patients with acute myocardial infarction and a left ventricular thrombus had significantly lower frequencies of 1) myocardial infarction in their family history (3% versus 11%, respectively), 2) hospital admission within 24 hours from the onset of chest pain (17% versus 50%, respectively), 3) thrombolytic therapy (8% versus 23%, respectively) and 4) current smoking (24% and 35%, respectively) than those without a left ventricular thrombus. In contrast, anterior infarction (81% versus 38%, respectively), left ventricular dilatation (30% versus 19%, respectively), dyskinesis of the left ventricular wall (23% versus 10%, respectively), an aneurysm (22% versus 7%, respectively) and a reduced systolic left ventricular function (ejection fraction < 40%) (28% versus 17%, respectively) were more frequent in the presence of a left ventricular thrombus after myocardial infarction. Multivariate analysis of the results revealed that the presence of anterior myocardial infarction and an aneurysm is associated with significantly increased hazard ratios. On the other hand, early hospitalization and a positive family history of infarction significantly lowered the hazard ratio. The frequency of a left ventricular thrombus was significantly higher in spring and winter.
The results presented in this paper confirm the significant hazard of certain parameters [location of infarction (anterior) and aneurysm] as concerns left ventricular thrombus formation among patients with acute myocardial infarction. Early hospitalization was found to lower the risk of thrombus formation. These echocardiographic and clinical parameters may be useful in the establishment of the individual risk of intracavital thrombus formation and may be of help in everyday medical practice.
对急性心肌梗死患者发生左心室血栓形成的临床流行病学及超声心动图危险因素进行回顾性研究。
对10年间连续治疗的1833例急性心肌梗死患者的数据进行回顾性分析。每位患者在入院65.0±5.5小时后接受经胸超声心动图检查。145例患者（7.9%）检测到左心室血栓。急性心肌梗死合并左心室血栓的患者在以下方面的发生率显著低于无左心室血栓的患者：1）家族史中心肌梗死发生率（分别为3%和11%）；2）胸痛发作后24小时内入院率（分别为17%和50%）；3）溶栓治疗率（分别为8%和23%）；4）当前吸烟率（分别为24%和35%）。相反，心肌梗死后合并左心室血栓的患者中，前壁梗死（分别为81%和38%）、左心室扩张（分别为30%和19%）、左心室壁运动障碍（分别为23%和10%）、室壁瘤（分别为22%和7%）以及左心室收缩功能降低（射血分数<40%）（分别为28%和17%）更为常见。结果的多因素分析显示，前壁心肌梗死和室壁瘤的存在与显著增加的风险比相关。另一方面，早期住院和梗死家族史阳性显著降低了风险比。左心室血栓的发生率在春季和冬季显著更高。
本文呈现的结果证实了某些参数[梗死部位（前壁）和室壁瘤]在急性心肌梗死患者左心室血栓形成方面具有显著风险。发现早期住院可降低血栓形成风险。这些超声心动图和临床参数可能有助于确定个体发生心腔内血栓形成的风险，并可能在日常医疗实践中有所帮助。
