Sacoransky Ethan, Yu Jia Ke Danny, Dave Prasham, Alexander Bryce, El Sherbini Adham, Abunassar Joseph, Abuzeid Wael
School of Medicine, Queen's University, Kingston, ON, Canada.
Division of Cardiology, Kingston Health Sciences Network, Kingston, ON, Canada.
Int J Cardiol Heart Vasc. 2024 Mar 29;52:101396. doi: 10.1016/j.ijcha.2024.101396. eCollection 2024 Jun.
Left ventricular thrombus (LVT) is a significant complication in STEMI. Previous studies were conducted prior to modern timely percutaneous reperfusion networks. Current expert opinion suggests incidence in the current era has decreased. We conducted a systematic review and -analysis to better understand the incidence and diagnosis of LVT in patients with STEMI treated with timely percutaneous techniques as assessed by multimodality imaging.
Cochrane, EMBASE, LILACS, and MEDLINE were searched over the last 10 years only including studies using contemporary techniques. The primary outcome was detection of LVT in patients via echocardiogram with or without contrast or Cardiac MRI (cMRI) following STEMI (both anterior and any territory) treated with PCI. Data was pooled across studies and statistical analysis was conducted via random effects model.
31 studies were included. 18 studies included data on any territory STEMI, totaling 14,172 patients, and an incidence of 5.6% [95% CI 4.3-7.0]. 18 studies were included in analysis for anterior STEMI, totaling 7382 patients and incidence of 12.7% [95% CI 9.8-15.6]. Relative to cMRI as a gold standard, the sensitivity of non-contrast echocardiography to detect LVT was 58.2% [95% CI 46.6-69.2] with a specificity of 97.8% [95% CI 96.3-98.8].
Incidence of LVT in STEMI patients treated with contemporary timely percutaneous revascularization is in keeping with historical data and remains significant, suggesting this remains an ongoing issue for further investigation. Numerically, both cMRI and contrast echo detected more LVT compared to non-contrast echo in any-territory STEMI patients.
左心室血栓（LVT）是ST段抬高型心肌梗死（STEMI）的一种严重并发症。以往的研究是在现代及时的经皮再灌注网络建立之前进行的。目前的专家意见表明，在当前时代其发病率已有所下降。我们进行了一项系统综述和分析，以更好地了解经多模态成像评估的采用及时经皮技术治疗的STEMI患者中LVT的发病率和诊断情况。
仅检索了过去10年的Cochrane、EMBASE、LILACS和MEDLINE数据库，纳入使用当代技术的研究。主要结局是在接受经皮冠状动脉介入治疗（PCI）的STEMI（前壁和任何区域）患者中，通过有或无造影剂的超声心动图或心脏磁共振成像（cMRI）检测LVT。对各研究的数据进行汇总，并通过随机效应模型进行统计分析。
纳入31项研究。18项研究纳入了任何区域STEMI的数据，共计14172例患者，发病率为5.6%[95%置信区间（CI）4.3 - 7.0]。18项研究纳入了前壁STEMI的分析，共计7382例患者，发病率为12.7%[95%CI 9.8 - 15.6]。相对于作为金标准的cMRI，非造影剂超声心动图检测LVT的敏感性为58.2%[95%CI 46.6 - 69.2]，特异性为97.8%[95%CI 96.3 - 98.8]。
采用当代及时经皮血管重建术治疗的STEMI患者中LVT的发病率与历史数据一致，且仍然较高，表明这仍是一个需要进一步研究的问题。从数值上看，在任何区域STEMI患者中，cMRI和造影剂增强超声心动图检测到的LVT均比非造影剂超声心动图更多。
