FREQUENCY OF LEFT VENTRICULAR THROMBUS IN PATIENTS WITH ACUTE ANTERIOR WALL MYOCARDIAL INFARCTION

Authors

  • M SAJJAD Department of cardiology, Gulab Devi Hospital Lahore, Pakistan
  • N ULLAH Department of cardiology, Rehmatul-lil-Alamen institute of cardiology, PESSI, Lahore, Pakistan
  • AE QURESHI Department of cardiology, Rehmatul-lil-Alamen institute of cardiology, PESSI, Lahore, Pakistan
  • H ANUM Department of cardiology, Rehmatul-lil-Alamen institute of cardiology, PESSI, Lahore, Pakistan
  • U FAROOQ Department of cardiology, Rehmatul-lil-Alamen institute of cardiology, PESSI, Lahore, Pakistan
  • WA DAR Department of Cardiology, Punjab cardiac and medical center Ravi Road Lahore, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2023i1.234

Keywords:

Myocardial infarction, Left ventricular thrombus, Echocardiography, Ejection fraction, Anterior wall MI

Abstract

Acute myocardial infarction (AMI) can be fatal and, if not, can result in many short- and long-term complications. Left ventricular thrombus (LVT) is an underrated complication that can lead to systemic embolization and, ultimately, stroke or end-organ damage. The current cross-sectional study is designed to determine the frequency of left ventricular thrombus after acute anterior wall myocardial infarction at the Department of Cardiology, Rehmatul-lil-Alameen Institute of Cardiology, Lahore, from 12-09-2020 to 11-03-2021. All patients of 20 to 60 years of either gender meeting the operational definition of the acute anterior wall were included. LV thrombus was diagnosed on echocardiography as an amorphous echogenic structure with variable shape and adherent to the endocardium. In this study, there were 87 cases; out of these, there were 57 (65.52%) males, and 30 (34.48%) females. The mean age of the subjects was 49.90±6.27 years. Out of 87 cases, 37 (42.53%) had a history of DM, 30 (45.98%) were hypertensive, and 31 (35.63%) were smokers. Left ventricular thrombus (LVT) was found in 16 (18.39%) cases. LVT was seen in 9 (15.79%) males vs. 7 (23.33%) females with p= 0.39. LVT was seen in 5 (13.51%) cases with DM and 11 (22%) with no DM, 7 (17.50%) cases with HTN, and 9 (19.15%) normotensives with p= 0.41 and 1.0. LVT was found in 5 (22.72%) cases with ejection fraction (EF) up to 40% and 11 (16.92%) cases with EF more than this with p= 0.18. Based on the results, the left ventricular thrombus is not uncommon after acute anterior wall MI and is nearly seen in every one out of five cases and is more common in cases with ejection fraction up to 40%.

Downloads

Download data is not yet available.

References

Al-Khatib, S. M., Stevenson, W. G., Ackerman, M. J., Bryant, W. J., Callans, D. J., Curtis, A. B., Deal, B. J., Dickfeld, T., Field, M. E., and Fonarow, G. C. (2018). 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology 72, e91-e220.

Camaj, A., Fuster, V., Giustino, G., Bienstock, S. W., Sternheim, D., Mehran, R., Dangas, G. D., Kini, A., Sharma, S. K., and Halperin, J. (2022). Left ventricular thrombus following acute myocardial infarction: JACC state-of-the-art review. Journal of the American College of Cardiology 79, 1010-1022.

Chamoun, A. J., McCulloch, M., Xie, T., Shah, S., and Ahmad, M. (2003). Real‐Time three‐dimensional echocardiography versus two‐dimensional echocardiography in the diagnosis of left ventricular apical thrombi: Preliminary findings. Journal of clinical ultrasound 31, 412-418.

CHAUDHRY, A. H., Nagra, H., AMIN, K., Kafeel, I., and SHAOUKAT, A. (2004). ACUTE ANTERIOR MYOCARDIAL INFARCTION: THE INCIDENCE OF LEFT VENTRICULAR THROMBUS. The Professional Medical Journal 11, 57-62.

Cohen, A., Donal, E., Delgado, V., Pepi, M., Tsang, T., Gerber, B., Soulat-Dufour, L., Habib, G., Lancellotti, P., and Evangelista, A. (2021). EACVI recommendations on cardiovascular imaging for the detection of embolic sources: endorsed by the Canadian Society of Echocardiography. European Heart Journal-Cardiovascular Imaging 22, e24-e57.

Costa, M., Grant, P. J., Rice, G. I., Futers, S. T., and Medcalf, R. L. (2001). Human endothelial cell-derived nuclear proteins that recognise polymorphic DNA elements in the von Willebrand factor gene promoter include YY1. Thrombosis and haemostasis 86, 672-679.

Delewi, R., Zijlstra, F., and Piek, J. J. (2012). Left ventricular thrombus formation after acute myocardial infarction. Heart 98, 1743-1749.

Habash, F., and Vallurupalli, S. (2017). Challenges in management of left ventricular thrombus. Therapeutic advances in cardiovascular disease 11, 203-213.

Iqbal, M. W., Fayyaz, A., and Hanif, A. (2014). Frequency of left ventricular thrombus after anterior wall ST-segment elevation acute Myocardial infarction. Annals of King Edward Medical University 20, 68-68.

Jadoon, R. J., Qureshi, A., Khan, S. A., Anwar, S. A., and Haroon, M. Z. (2014). Left ventricular thrombus in patients with acute anterior wall myocardial infarction. Journal of Ayub Medical College Abbottabad 26, 491-5.

Kamberi, L. S., Karabulut, A. M., Çitaku, H. R., Gorani, D. R., and Beqiri, A. I. (2011). Incidence of early Left ventricular thrombus and stroke after acute Myocardial infarction in the Primary coronary Intervention era compared to conservative treatment. Acta Informatica Medica 19, 88.

Lai, E., Alishetti, S., Wong, J., Delic, L., Rosenblatt, A., and Egrie, G. (2019). Right ventricular thrombus in transit: raising the stakes in the management of pulmonary embolism. Journal of the American College of Cardiology 73, 2844-2844.

Magdás, A., Podoleanu, C., and Frigy, A. (2021). Extensive Left Ventricular Thrombosis with Concomitant Pulmonary Embolism. Clinics and Practice 11, 303-308.

Mostofsky, E., Maclure, M., Sherwood, J. B., Tofler, G. H., Muller, J. E., and Mittleman, M. A. (2012). Risk of acute myocardial infarction after the death of a significant person in one's life: the Determinants of Myocardial Infarction Onset Study. Circulation 125, 491-496.

Okuyan, E., Okcun, B., Dinçkal, M. H., and Mutlu, H. (2010). Risk factors for development of left ventricular thrombus after first acute anterior myocardial infarction-association with anticardiolipin antibodies. Thrombosis journal 8, 1-7.

Olsen, F. J., Pedersen, S., Galatius, S., Fritz-Hansen, T., Gislason, G., and Biering-Sørensen, T. (2020). Association between regional longitudinal strain and left ventricular thrombus formation following acute myocardial infarction. The international journal of cardiovascular imaging 36, 1271-1281.

Orimoloye, O. A., Budoff, M. J., Dardari, Z. A., Mirbolouk, M., Uddin, S. I., Berman, D. S., Rozanski, A., Shaw, L. J., Rumberger, J. A., and Nasir, K. (2018). Race/ethnicity and the prognostic implications of coronary artery calcium for all‐cause and cardiovascular disease mortality: the coronary artery calcium consortium. Journal of the American Heart Association 7, e010471.

Rathi, N. L., RK, S., and NA, M. (2009). Left ventricular thrombus in acute myocardial infarction. Pakistan Heart Journal 42.

Rehan, A., Kanwar, M., Rosman, H., Ahmed, S., Ali, A., Gardin, J., and Cohen, G. (2006). Incidence of post myocardial infarction left ventricular thrombus formation in the era of primary percutaneous intervention and glycoprotein IIb/IIIa inhibitors. A prospective observational study. Cardiovascular ultrasound 4, 1-5.

Rosamond, W., Flegal, K., Friday, G., Furie, K., Go, A., Greenlund, K., Haase, N., Ho, M., Howard, V., and Kissela, B. (2007). Heart disease and stroke statistics—2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 115, e69-e171.

Saric, M., Armour, A. C., Arnaout, M. S., Chaudhry, F. A., Grimm, R. A., Kronzon, I., Landeck, B. F., Maganti, K., Michelena, H. I., and Tolstrup, K. (2016). Guidelines for the use of echocardiography in the evaluation of a cardiac source of embolism. Journal of the American Society of Echocardiography 29, 1-42.

Singh, A. P., Kayal, V., and Nath, R. K. (2021). Aortic Dissection With Complete Occlusion of Left Main Coronary Artery Presenting as Acute ST-Segment Elevation Myocardial Infarction. Cureus 13.

Solheim, S., Seljeflot, I., Lunde, K., Bjørnerheim, R., Aakhus, S., Forfang, K., and Arnesen, H. (2010). Frequency of left ventricular thrombus in patients with anterior wall acute myocardial infarction treated with percutaneous coronary intervention and dual antiplatelet therapy. The American journal of cardiology 106, 1197-1200.

Vogel, B., Claessen, B. E., Arnold, S. V., Chan, D., Cohen, D. J., Giannitsis, E., Gibson, C. M., Goto, S., Katus, H. A., and Kerneis, M. (2019). ST-segment elevation myocardial infarction. Nature reviews Disease primers 5, 39.

Weinsaft, J. W., Kim, H. W., Crowley, A. L., Klem, I., Shenoy, C., Van Assche, L., Brosnan, R., Shah, D. J., Velazquez, E. J., and Parker, M. (2011). LV thrombus detection by routine echocardiography: insights into performance characteristics using delayed enhancement CMR. JACC: Cardiovascular Imaging 4, 702-712.

Downloads

Published

2023-04-10

How to Cite

SAJJAD, M., ULLAH, N., QURESHI, A., ANUM, H., FAROOQ, U., & DAR, W. (2023). FREQUENCY OF LEFT VENTRICULAR THROMBUS IN PATIENTS WITH ACUTE ANTERIOR WALL MYOCARDIAL INFARCTION. Biological and Clinical Sciences Research Journal, 2023(1), 234. https://doi.org/10.54112/bcsrj.v2023i1.234

Most read articles by the same author(s)