Weinreich D J, Burke J F, Pauletto F J
Ann Intern Med. 1984 Jun;100(6):789-94. doi: 10.7326/0003-4819-100-6-789.
To determine the clinical significance of left ventricular thrombi, we used two-dimensional echocardiography to study 261 patients with acute transmural myocardial infarction. Mural thrombi were found in 46 patients. This complication occurred in 34% (44 of 130) of anterior wall infarctions but in only 1.5% (2 of 131) of inferior wall infarctions. An apical wall motion abnormality was present in all patients with thrombus. Severe depression of left ventricular function was not a prerequisite for thrombus formation: the mean left ventricular ejection fraction was 37 +/- 1.5%. Forty-three patients with left ventricular thrombi were followed for a mean duration of 15 months with serial echocardiography. None of the 25 patients who received anticoagulation treatment had an embolic event. Embolization occurred in 7 of 18 patients who had not received anticoagulation treatment. All embolic events occurred within 4 months of infarction. Although anticoagulation treatment appeared to provide protection against embolic events, the prevalence of left ventricular thrombi on follow-up echocardiographic study was essentially the same whether or not this treatment was used.
为了确定左心室血栓的临床意义，我们使用二维超声心动图对261例急性透壁性心肌梗死患者进行了研究。在46例患者中发现了壁血栓。这种并发症在前壁梗死患者中发生率为34%（130例中的44例），而在下壁梗死患者中仅为1.5%（131例中的2例）。所有有血栓的患者均存在心尖壁运动异常。左心室功能严重减退并非血栓形成的必要条件：左心室平均射血分数为37±1.5%。对43例左心室血栓患者进行了平均15个月的随访，期间进行了系列超声心动图检查。接受抗凝治疗的25例患者均未发生栓塞事件。未接受抗凝治疗的18例患者中有7例发生了栓塞。所有栓塞事件均发生在梗死4个月内。尽管抗凝治疗似乎可预防栓塞事件，但无论是否使用这种治疗，随访超声心动图研究中左心室血栓的发生率基本相同。
