Asinger R W, Mikell F L, Elsperger J, Hodges M
N Engl J Med. 1981 Aug 6;305(6):297-302. doi: 10.1056/NEJM198108063050601.
To study the incidence of left-ventricular thrombosis after transmural myocardial infarction, we performed serial two-dimensional echocardiography in 70 consecutive patients. Thirty-five patients had inferior-wall infarction: none had a left-ventricular thrombus. The other 35 had anterior-wall infarction: 12 had left-ventricular thrombi. Thrombi were diagnosed an average of five days after the infarction (range, one to 11 days). All patients with left-ventricular thrombi had severe apical-wall-motion abnormalities (akinesis or dyskinesis). Twenty-six of the 35 patients with anterior infarctions had apical akinesis or dyskinesis on echocardiography; left-ventricular thrombi developed in 12 of these 26 (46 per cent). We conclude that patients with severe apical-wall-motion abnormalities during acute transmural anterior myocardial infarction are at high risk for left-ventricular thrombosis. This high-risk group can be identified before the development of left-ventricular thrombi. Patients with inferior infarction or anterior infarction without a severe apical-wall-motion abnormality are at low risk.
为研究透壁性心肌梗死后左心室血栓形成的发生率，我们对70例连续患者进行了系列二维超声心动图检查。35例患者为下壁梗死：无一例有左心室血栓。另外35例为前壁梗死：12例有左心室血栓。血栓平均在梗死后5天被诊断出来（范围为1至11天）。所有有左心室血栓的患者均有严重的心尖壁运动异常（运动不能或运动障碍）。35例前壁梗死患者中，26例在超声心动图上有心尖运动不能或运动障碍；这26例中的12例（46%）发生了左心室血栓。我们得出结论，急性透壁性前壁心肌梗死期间有心尖壁严重运动异常的患者发生左心室血栓的风险很高。这个高危组可在左心室血栓形成之前被识别出来。下壁梗死或无严重心尖壁运动异常的前壁梗死患者风险较低。
