Bertolin-Boronat Carlos, Marcos-Garcés Víctor, Merenciano-González Hector, Perez Nerea, Pérez Del Villar Candelas, Gavara Jose, Lopez-Lereu Maria P, Monmeneu Jose V, Herrera Flores Cristian, Domenech-Ximenos Blanca, López-Fornás Francisco Jesús, Rios-Navarro Cesar, de Dios Elena, Moratal David, Ortiz-Pérez Jose T, Bayes-Genis Antoni, Rodríguez-Palomares Jose F, Nuñez Julio, Sánchez Pedro L, Sanchis Juan, Bodi Vicente
Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain; INCLIVA Biomedical Research Institute, Valencia, Spain.
Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain; INCLIVA Biomedical Research Institute, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain.
Eur J Intern Med. 2025 Jan;131:104-112. doi: 10.1016/j.ejim.2024.09.015. Epub 2024 Oct 8.
Left ventricular thrombus (LVTh) is a severe complication after ST-segment elevation myocardial infarction (STEMI).
We aim to predict LVTh occurrence by cardiac magnetic resonance (CMR) using clinical, echocardiographic, and electrocardiographic (ECG) variables readily available at admission.
We included 590 reperfused STEMI patients who underwent early (1-week) and/or late (6-month) CMR in our institution. Baseline clinical, echocardiographic (left ventricular ejection fraction -LVEF-) and ECG data (summatory of ST-segment elevation -sum-STE- and Q-wave and residual ST-elevation >1 mm -Q-STE-) during admission were registered. Multivariate binary logistic regression models and receiver operating characteristic curves were computed for LVTh prediction.
LVTh was detected by CMR in 43 (7.3 %) patients and was predicted by previous chronic coronary syndrome (CCS, HR 4.74 [1.82-12.35], p = 0.001), anterior STEMI (HR 10.93 [2.47-48.31], p = 0.002), LVEF (HR 0.96 [0.93-0.99] per %, p = 0.008), maximum sum-STE (HR 1.04 [1.01-1.07] per mm, p = 0.04), and Q-STE (HR 1.31 [1.08-1.6] per lead, p = 0.008). High-risk patients with both major (anterior STEMI and Q-STE in ≥1 leads) and 1-3 minor (CCS, maximum sum-STE >10 mm, LVEF <50%) factors showed the highest LVTh risk (19.6 % within 6 months). The model showed excellent discrimination ability (area under the curve=0.85 [0.81-0.9], p < 0.001). Simplified 4-variable (excluding sum-STE) and 3-variable (also excluding CCS) risk scores showed similar discrimination ability and were externally validated.
LVTh within 6 months post-STEMI can be predicted using pre-discharge clinical (anterior infarction and CCS), echocardiographic (LVEF), and ECG (sum-STE and Q-STE) data. Our results can help select patients who should undergo CMR after STEMI for LVTh detection.
左心室血栓（LVTh）是ST段抬高型心肌梗死（STEMI）后的一种严重并发症。
我们旨在通过心脏磁共振成像（CMR），利用入院时 readily available 的临床、超声心动图和心电图（ECG）变量来预测LVTh的发生。
我们纳入了590例在我院接受早期（1周）和/或晚期（6个月）CMR检查的再灌注STEMI患者。记录入院时的基线临床、超声心动图（左心室射血分数-LVEF-）和ECG数据（ST段抬高总和-sum-STE-以及Q波和残余ST段抬高>1mm-Q-STE-）。计算多变量二元逻辑回归模型和受试者工作特征曲线以预测LVTh。
CMR检测到43例（7.3%）患者存在LVTh，预测因素为既往慢性冠状动脉综合征（CCS，HR 4.74[1.82 - 12.35]，p = 0.001）、前壁STEMI（HR 10.93[2.47 - 48.31]，p = 0.002）、LVEF（每降低1%，HR 0.96[0.93 - 0.99]，p = 0.008）、最大sum-STE（每增加1mm，HR 1.04[1.01 - 1.07]，p = 0.04）以及Q-STE（每增加1导联，HR 1.31[1.08 - 1.6]，p = 0.008）。同时具有主要因素（前壁STEMI和≥1导联的Q-STE）和1 - 3个次要因素（CCS、最大sum-STE>10mm、LVEF<50%）的高危患者显示出最高的LVTh风险（6个月内为19.6%）。该模型显示出出色的鉴别能力（曲线下面积=0.85[0.81 - 0.9]，p<0.001）。简化的4变量（不包括sum-STE）和3变量（也不包括CCS）风险评分显示出相似的鉴别能力，并得到了外部验证。
STEMI后6个月内的LVTh可通过出院前的临床（前壁梗死和CCS）、超声心动图（LVEF）和ECG（sum-STE和Q-STE）数据进行预测。我们的结果有助于选择STEMI后应接受CMR检查以检测LVTh的患者。
