Penco M, Romano S, Mallus M T, Dagianti A, Fedele F, Dagianti A
Dipartimento di Medicina Interna, Università degli Studi Tor Vergata, Roma.
Cardiologia. 1993 Mar;38(3):157-61.
Five hundred twenty-nine patients with acute myocardial infarction (AMI) underwent clinical, enzymatic and echocardiographic evaluation. Two-dimensional echocardiography identified 71 patients with left ventricular thrombus (LVT): 63 males and 8 females; mean age 54 +/- 12 years; 70 with anterior AMI and 1 with inferior AMI. The incidence of LVT was 13.8% and 27.7% among anterior AMI. At admission to Coronary Care Unit the patients with LVT showed more extensive left ventricular dysfunction than patients without LVT: Killip classification > or = 2 was 54.5% versus 41.4%, p < 0.05; peak of creatinphosphokinase was 1337 UI/L versus 951 UI/L, p < 0.05; echo-score was 7.2 +/- 2.8 versus 4.7 +/- 3.5, p < 0.01. Serial echocardiograms showed disappearance of LVT in 24 patients. Regarding regional wall motion abnormalities, patients with LVT disappearance showed lower pre-discharge echo-scores than patients with LVT persistence (6.7 +/- 2.2 versus 8.4 +/- 2.9; p < 0.01) although echo-scores at admission were similar in the 2 groups (7.1 +/- 1.1 versus 7.3 +/- 3.4, NS). These results suggest: the importance of extension of myocardial infarction and left ventricular dysfunction in LVT evolution; the importance of treatment limiting infarct size and improving left ventricular function, such as thrombolytic therapy. Anticoagulant therapy could be limited to patients with higher risk of embolization (as the protruding shape of LVT).
529例急性心肌梗死（AMI）患者接受了临床、酶学及超声心动图评估。二维超声心动图检查发现71例左心室血栓（LVT）患者：男性63例，女性8例；平均年龄54±12岁；前壁AMI患者70例，下壁AMI患者1例。LVT在前壁AMI中的发生率分别为13.8%和27.7%。入住冠心病监护病房时，LVT患者的左心室功能障碍比无LVT患者更广泛：Killip分级≥2级分别为54.5%和41.4%，p<0.05；肌酸磷酸激酶峰值分别为1337 UI/L和951 UI/L，p<0.05；超声心动图评分分别为7.2±2.8和4.7±3.5，p<0.01。系列超声心动图显示24例患者的LVT消失。关于节段性室壁运动异常，LVT消失的患者出院前超声心动图评分低于LVT持续存在的患者（6.7±2.2对8.4±2.9；p<0.01），尽管两组入院时的超声心动图评分相似（7.1±1.1对7.3±3.4，无显著性差异）。这些结果提示：心肌梗死范围扩大和左心室功能障碍在LVT演变中的重要性；限制梗死面积和改善左心室功能的治疗的重要性，如溶栓治疗。抗凝治疗可仅限于栓塞风险较高的患者（如LVT呈突出状）。
