Mao Tiffany F, Bajwa Ata, Muskula Preetham, Coggins Tina R, Kennedy Kevin, Magalski Anthony, Skolnick David G, Main Michael L
Department of Cardiovascular Diseases, Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
Department of Cardiovascular Diseases, Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
Am J Cardiol. 2018 Jan 1;121(1):27-31. doi: 10.1016/j.amjcard.2017.09.010. Epub 2017 Oct 10.
Previous studies using 2-dimensional non-contrast echocardiography have reported a post-ST segment elevation myocardial infarction (STEMI) left ventricular (LV) thrombus incidence of 3% to 24%. However, these studies were not performed with ultrasound contrast agents (UCAs), which improve accuracy in the diagnosis of LV thrombus. We aimed to determine the early incidence and clinical correlates of LV thrombus in a large consecutive cohort of patients with STEMI. This study included consecutive patients admitted to Saint Luke's Mid America Heart Institute with STEMI who also underwent early percutaneous coronary intervention (PCI) and an echocardiogram. A total of 1,698 patients (1,205 men, mean age 61 ± 13 years) comprised the study group. Echocardiography was performed on hospital day 2, and a UCA was used in 1,292 patients (76%). LV thrombus was identified in 28 (1.6%) patients. A multivariable logistic regression model showed that left anterior descending intervention was independently associated with LV thrombus (odds ratio = 7.58, 95% confidence interval [CI] 2.20 to 26.19, p = 0.001), thrombolysis in myocardial infarction III flow was marginally associated with less LV thrombus (odds ratio = 0.41, 95% CI 0.16 to 1.04, p = 0.060), and higher LVEF was associated with less LV thrombus (odds ratio = 0.96, 95% CI 0.91 to 0.97, p <0.001). In conclusion, LV thrombus was identified in only 1.6% of patients in a large STEMI cohort, significantly lower than previous studies. A UCA was used in most echocardiograms, and it improves accuracy in the detection and exclusion of LV thrombus.
以往使用二维非对比超声心动图的研究报告显示，ST段抬高型心肌梗死（STEMI）患者左心室（LV）血栓的发生率为3%至24%。然而，这些研究并未使用超声造影剂（UCA），而超声造影剂可提高LV血栓诊断的准确性。我们旨在确定一大组连续性STEMI患者中LV血栓的早期发生率及其临床相关因素。本研究纳入了连续入住圣卢克中美心脏研究所且患有STEMI并接受早期经皮冠状动脉介入治疗（PCI）和超声心动图检查的患者。共有1698例患者（1205例男性，平均年龄61±13岁）组成研究组。在住院第2天进行超声心动图检查，1292例患者（76%）使用了UCA。28例（1.6%）患者发现有LV血栓。多变量逻辑回归模型显示，左前降支介入治疗与LV血栓独立相关（比值比=7.58，95%置信区间[CI]2.20至26.19，p=0.001），心肌梗死溶栓III级血流与LV血栓较少存在边缘相关性（比值比=0.41，95%CI 0.16至1.04，p=0.060），较高的左心室射血分数（LVEF）与LV血栓较少相关（比值比=0.96，95%CI 0.91至0.97，p<0.001）。总之，在一大组STEMI队列中，仅1.6%的患者发现有LV血栓，显著低于以往研究。大多数超声心动图检查使用了UCA，其提高了LV血栓检测和排除的准确性。
