Mansencal Nicolas, Nasr Imad Abi, Pillière Rémy, Farcot Jean-Christian, Joseph Thierry, Lacombe Pascal, Dubourg Olivier
Cardiology Department, University Hospital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, UFR de médecine Paris-Ile de France-Ouest, Faculté de Versailles-Saint Quentin en Yveline, Boulogne, France.
Am J Cardiol. 2007 Jun 15;99(12):1667-70. doi: 10.1016/j.amjcard.2007.01.046. Epub 2007 May 2.
Fifty consecutive patients referred to a coronary care unit for acute anterior myocardial infarction with ST-segment elevation underwent coronary arteriography, left ventricular (LV) angiography, and revascularization. Transthoracic echocardiography was systematically performed using fundamental imaging, second harmonic imaging, and contrast agents to assess the LV chamber. Six patients (12%) presented with a confirmed LV mural thrombus. Thirty-five percent of patients with time to revascularization>3 hours presented with an LV mural thrombus versus 0 patients with time to revascularization<or=3 hours (p=0.003). The most accurate method of detecting LV mural thrombus was contrast echocardiography regardless of physician experience. No patient with a misdiagnosis of thrombus had an optimal acoustic window using fundamental imaging or second harmonic imaging. In conclusion, patients presenting with acute anterior myocardial infarction could benefit from contrast echocardiography for assessment of LV mural thrombus when acoustic windows are suboptimal and time to revascularization is >3 hours.
连续50例因急性前壁心肌梗死伴ST段抬高而入住冠心病监护病房的患者接受了冠状动脉造影、左心室（LV）血管造影和血运重建治疗。采用基本成像、二次谐波成像和造影剂系统地进行经胸超声心动图检查，以评估左心室腔。6例患者（12%）经证实存在左心室壁血栓。血运重建时间>3小时的患者中有35%出现左心室壁血栓，而血运重建时间≤3小时的患者中无此情况（p=0.003）。无论医生经验如何，检测左心室壁血栓最准确的方法是超声造影。在基本成像或二次谐波成像时，没有因血栓误诊的患者具有最佳的声学窗口。总之，当声学窗口不理想且血运重建时间>3小时时，急性前壁心肌梗死患者可受益于超声造影评估左心室壁血栓。
