Van Dantzig J M, Delemarre B J, Bot H, Koster R W, Visser C A
Academic Medical Center, Department of Cardiology, Amsterdam, The Netherlands.
J Am Coll Cardiol. 1995 May;25(6):1341-6. doi: 10.1016/0735-1097(94)00548-5.
The value of Doppler-derived left ventricular spatial flow patterns in predicting left ventricular thrombus formation after myocardial infarction was compared with that of conventional clinical and echocardiographic variables.
Assessment of left ventricular thrombosis risk after myocardial infarction is important because of potential embolic sequelae that are reduced by oral anticoagulant agents.
Clinical, two-dimensional and Doppler echocardiographic data were prospectively obtained in 104 patients with acute myocardial infarction within 48 h of admission. Ventricular flow was assessed by Doppler echocardiography and considered normal when brisk ventricular inflow with simultaneous onset at the mitral valve and apical levels was present, together with alternating directions of apical flow throughout the cardiac cycle. In addition to normal flow, two abnormal flow patterns were recognized: apical rotating flow and vortex ring formation. Oral anticoagulant agents were prescribed only to patients with abnormal flow at admission. The incidence of left ventricular thrombosis was assessed by echocardiography during 9 months of follow-up.
Abnormal flow pattern had a positive predictive value of 63% and a negative predictive value of 99%. On stepwise logistic regression analysis, only abnormal flow pattern had an independent relation to left ventricular thrombus (odds ratio 92).
Left ventricular flow pattern derived by Doppler echocardiography soon after admission is superior to conventional clinical and two-dimensional echocardiographic assessment in estimating the risk of left ventricular thrombosis after myocardial infarction.
将多普勒衍生的左心室空间血流模式预测心肌梗死后左心室血栓形成的价值与传统临床及超声心动图变量的价值进行比较。
由于口服抗凝剂可降低潜在的栓塞后遗症风险，因此评估心肌梗死后左心室血栓形成风险很重要。
前瞻性收集了104例入院48小时内的急性心肌梗死患者的临床、二维及多普勒超声心动图数据。通过多普勒超声心动图评估心室血流，当二尖瓣和心尖水平同时出现轻快的心室流入且整个心动周期中心尖血流方向交替时，认为血流正常。除正常血流外，还识别出两种异常血流模式：心尖旋转血流和涡环形成。仅对入院时血流异常的患者开具口服抗凝剂。在9个月的随访期间，通过超声心动图评估左心室血栓形成的发生率。
异常血流模式的阳性预测值为63%，阴性预测值为99%。在逐步逻辑回归分析中，只有异常血流模式与左心室血栓有独立关系（比值比92）。
入院后不久通过多普勒超声心动图得出的左心室血流模式在评估心肌梗死后左心室血栓形成风险方面优于传统临床及二维超声心动图评估。
