Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
Int J Cardiovasc Imaging. 2020 Jul;36(7):1271-1281. doi: 10.1007/s10554-020-01825-5. Epub 2020 Mar 29.
Left ventricular thrombus (LVT) formation is a dangerous complication to acute myocardial infarction (MI). We hypothesized that regional longitudinal strain impairment is associated with LVT formation. We included 373 prospectively enrolled patients with ST-segment elevation MI. All patients had an echocardiogram performed a median of 2 days post-MI. Using logistic regression, we investigated the relation between LVT and left ventricular (LV) speckle tracking, conventional echocardiographic measures and well-known echocardiographic features of LVT formation including LV smoke, aneurysm and valvular regurgitation. Overall, the mean age was 62 years of age, 75% were men, 5% had prior MI, and 48% had anterior infarcts. Mean LVEF was 46% and global longitudinal strain (GLS) was - 12%. Of 373 patients, 31 (8%) developed LVT on echocardiograms. Patients with LVT more frequently had anterior infarcts, prior MI, lower LVEF, lower e', lower GLS and regional strain, and these were all associated with LVT formation in univariable analyses. In multivariable analysis (including anterior infarcts, prior MI, LVEF, e'), GLS and regional strain remained independently associated with LVT formation (GLS: OR = 1.17 (1.00-1.36), midventricular strain: OR = 1.19 (1.03-1.38), apical strain: OR = 1.12 (1.00-1.25), per 1% absolute decrease, p < 0.05 for all]. In a combined diagnostic model, including anterior infarct, impaired LVEF (< 42%) and apical strain (> - 8%), the sensitivity and negative predictive value was 100%, with a specificity and positive predictive value of 38 and 13%, respectively. In MI patients, non-anterior infarct, preserved LVEF and apical strain can rule out LVT formation. Reduced apical strain indicates a markedly increased LVT risk.
左心室血栓（LVT）形成是急性心肌梗死（MI）的一种危险并发症。我们假设节段纵向应变损害与 LVT 形成有关。我们纳入了 373 例前瞻性 ST 段抬高型 MI 患者。所有患者在 MI 后中位数 2 天内行超声心动图检查。使用逻辑回归，我们研究了 LVT 与左心室（LV）斑点追踪、常规超声心动图测量以及 LVT 形成的公认超声心动图特征（包括 LV 烟雾、动脉瘤和瓣膜反流）之间的关系。总体而言，患者平均年龄为 62 岁，75%为男性，5%有既往 MI，48%有前壁梗死。平均 LVEF 为 46%，整体纵向应变（GLS）为-12%。373 例患者中，31 例（8%）在超声心动图上出现 LVT。LVT 患者更常发生前壁梗死、既往 MI、较低的 LVEF、较低的 e'、较低的 GLS 和节段应变，这些在单变量分析中均与 LVT 形成相关。多变量分析（包括前壁梗死、既往 MI、LVEF、e'）包括 GLS 和节段应变与 LVT 形成独立相关（GLS：OR=1.17（1.00-1.36），中室应变：OR=1.19（1.03-1.38），心尖应变：OR=1.12（1.00-1.25），每降低 1%绝对值，p<0.05）。在包括前壁梗死、受损的 LVEF（<42%）和心尖应变（>−8%）的联合诊断模型中，敏感性和阴性预测值为 100%，特异性和阳性预测值分别为 38%和 13%。在 MI 患者中，非前壁梗死、保留的 LVEF 和心尖应变可以排除 LVT 形成。心尖应变降低表明 LVT 风险显著增加。
