Wang Meng, Li Mengwan, Liu Wenheng, Li Jian, Chen Dan, Wang Ziqing, Guo Qilong, Mi Shouling, Ge Junhua
Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao Municipal Key Laboratory of Hypertension (Key Laboratory of Cardiovascular Medicine), 266000 Qingdao, Shandong, China.
Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, 200032 Shanghai, China.
Rev Cardiovasc Med. 2025 May 8;26(5):28222. doi: 10.31083/RCM28222. eCollection 2025 May.
The clinical prognosis of ST-elevation myocardial infarction (STEMI) patients with mural thrombus in left ventricular aneurysm (MTLVA) remains poor; moreover, the risk factors associated with the non-resolution (persistent or recurrent) of MTLVA are not well understood. This study aimed to identify independent risk factors for MTLVA non-resolution.
A total of 133 STEMI patients (mean age 62 ± 11 years, 80.5% male) with MTLVA, admitted to our department between 2014 and 2022, were included in this retrospective analysis. Patients were categorized into two groups: resolution (n = 59) and non-resolution [persistent (n = 72) or recurrent (n = 2) MTLVA; n = 74]. The median follow-up duration was 25 months, during which adverse events were monitored, including stroke, re-revascularization, major bleeding, systemic embolism, and cardiac death.
The prevalence of non-resolution was 55.6%. Non-resolution was significantly associated with elevated lipoprotein (a) [Lp(a)] levels (>270 mg/L, hazard ratios (HR) 2.270, = 0.003), larger left ventricular aneurysm (LVA) area (>4.5 cm, HR 4.038, < 0.001), and greater mural thrombus (MT) area (>2.2 cm, HR 2.40, = 0.002), independent of other risk factors, such as hypercholesterolemia and left circumflex artery (LCX)-related STEMI. Baseline left ventricular ejection fraction (LVEF) was lower in the non-resolution group (41.7% vs. 45.7%, = 0.008). During follow-up, the LVEF remained lower in the non-resolution group and increased in the resolution group. The composite of adverse events was significantly higher in the non-resolution group (28.4% vs. 8.5%, = 0.003), including stroke ( = 0.025) and systemic embolism ( = 0.034).
Independent risk factors for thrombus non-resolution in STEMI patients with MTLVA include elevated Lp(a), larger LVA and MT areas. These factors contribute to thrombus persistence and are associated with worse clinical outcomes. However, further studies are needed to assess targeted management strategies for high-risk patients.
左心室室壁瘤合并附壁血栓（MTLVA）的ST段抬高型心肌梗死（STEMI）患者临床预后仍然较差；此外，与MTLVA未消退（持续或复发）相关的危险因素尚未完全明确。本研究旨在确定MTLVA未消退的独立危险因素。
本回顾性分析纳入了2014年至2022年间在我科住院的133例MTLVA的STEMI患者（平均年龄62±11岁，男性占80.5%）。患者分为两组：消退组（n = 59）和未消退组[持续性（n = 72）或复发性（n = 2）MTLVA；n = 74]。中位随访时间为25个月，在此期间监测不良事件，包括中风、再次血运重建、大出血、全身栓塞和心源性死亡。
未消退的患病率为55.6%。未消退与脂蛋白（a）[Lp（a）]水平升高（>270 mg/L，危险比（HR）2.270， = 0.003）、更大的左心室室壁瘤（LVA）面积（>4.5 cm，HR 4.038， < 0.001）和更大的附壁血栓（MT）面积（>2.2 cm，HR 2.40， = 0.002）显著相关，独立于其他危险因素，如高胆固醇血症和左旋支动脉（LCX）相关的STEMI。未消退组的基线左心室射血分数（LVEF）较低（41.7%对45.7%， = 0.008）。随访期间，未消退组的LVEF仍然较低，而消退组则升高。未消退组不良事件的复合发生率显著更高（28.4%对8.5%， = 0.003），包括中风（ = 0.025）和全身栓塞（ = 0.034）。
MTLVA的STEMI患者血栓未消退的独立危险因素包括Lp（a）升高、更大的LVA和MT面积。这些因素导致血栓持续存在，并与更差的临床结局相关。然而，需要进一步研究以评估高危患者的靶向管理策略。
