[Ventricular thrombi in the chronic infarct stage: echocardiographic findings, clinical aspects, relations to anticoagulation].

In 10% (n = 139) of 1,383 patients in the chronic phase of myocardial infarction left ventricular mural thrombi on a-/dyskinetic segments were present in the 2D-echocardiogram. Thrombi were more often seen in patients with anterior wall infarct (14% of 734) or combined anterior-posterior infarcts (11% of 337) than in those with posterior wall infarct (0.6% of 312). Thrombi were most frequent in patients with left ventricular aneurysm (26% of 362). Generally, our patients with left ventricular thrombi had suffered large infarctions, involving on average 42% of the wall segments. Accordingly, signs of severe left ventricular damage were found in most of these patients: in 69% global ventricular dilation was present in the echocardiogram, in 64% the global heart size, determined by chest-ray was enlarged, in 42% the exercise tolerance on the bicycle ergometer was limited to 25 watts or less, 29% had congestive heart failure, and 17% severe ventricular arrhythmias. Systemic embolization had occurred in 7.9% of the 132 thrombus patients, but in only 0.7% of the 1,244 patients without thrombi. At the time of the thrombus diagnosis by means of 2D-echocardiography, 90% of the thrombus patients had not received effective anticoagulant therapy. Follow-up was possible in 65 of these patients and showed thrombus regression in 45 patients, 93% of whom were effectively anticoagulated. Of the 20 patients with persisting thrombi only 20% were under an effective anticoagulant drug management. If anticoagulant therapy has to be stopped, a former thrombus patient runs a high risk of developing thrombi also in the chronic phase of myocardial infarction.