Johannessen K A, Nordrehaug J E, von der Lippe G, Vollset S E
Cardiology Section, Diakonissehjemmets Hospital, Bergen, Norway.
Br Heart J. 1988 Aug;60(2):104-10. doi: 10.1136/hrt.60.2.104.
Risk factors for systemic embolisation in patients with ventricular thrombi caused by an acute myocardial infarction were studied in 150 consecutive patients with an infarction of the anterior wall. Serial echocardiograms were performed 2-10 days after the acute event and patients were followed up for three months. Anticoagulation treatment was started only after the detection of thrombi. Of the 55 patients in whom a thrombus developed, 15 (27%) had peripheral emboli between 6-62 days; but only two (2%) of 95 patients without thrombus had emboli. Among 15 variables, the best single predictors of embolisation were age greater than 68 years (80% sensitive, 85% specific), pendulous thrombus (60%, 93%), and independent thrombus mobility (60%, 85%). Logistic regression analysis showed that a formula that included patient age, thrombus area, and the length of thrombus in the ventricular lumen predicted embolisation (sensitivity 87%, specificity 88%). There was no correlation between age and the thrombus variables. The risk of embolisation from left ventricular thrombi in acute anterior myocardial infarction can be accurately assessed from patient age and echocardiographic features. The risk of peripheral emboli is high in patients with left ventricular thrombi and those aged greater than 68.
对150例连续的前壁心肌梗死患者发生的急性心肌梗死所致心室血栓患者的全身栓塞危险因素进行了研究。在急性事件发生后2 - 10天进行系列超声心动图检查，并对患者进行3个月的随访。仅在检测到血栓后才开始抗凝治疗。在发生血栓的55例患者中，15例（27%）在6 - 62天之间发生了外周栓塞；但在95例无血栓的患者中，只有2例（2%）发生了栓塞。在15个变量中，栓塞的最佳单一预测因素是年龄大于68岁（敏感性80%，特异性85%）、摆动性血栓（60%，93%）和独立的血栓移动性（60%，85%）。逻辑回归分析表明，一个包括患者年龄、血栓面积和心室腔内血栓长度的公式可预测栓塞（敏感性87%，特异性88%）。年龄与血栓变量之间无相关性。急性前壁心肌梗死患者左心室血栓的栓塞风险可根据患者年龄和超声心动图特征准确评估。左心室血栓患者和年龄大于68岁的患者外周栓塞风险较高。
