Prediction of left ventricular thrombus after myocardial infarction: a cardiac magnetic resonance-based prospective registry
Por:
Bertolin-Boronat C, Marcos-Garcés V, Merenciano-González H, Perez N, Pérez Del Villar C, Gavara J, Lopez-Lereu MP, Monmeneu JV, Herrera Flores C, Domenech-Ximenos B, López-Fornás FJ, Rios-Navarro C, De Dios E, Moratal D, Ortiz-Pérez JT, Bayes-Genis A, Rodríguez-Palomares JF, Nuñez J, Sánchez PL, Sanchis J, Bodi V
Publicada:
1 ene 2025
Ahead of Print:
1 ene 2025
Resumen:
Background: Left ventricular thrombus (LVTh) is a severe complication after ST-segment elevation myocardial infarction (STEMI). Objectives: We aim to predict LVTh occurrence by cardiac magnetic resonance (CMR) using clinical, echocardiographic, and electrocardiographic (ECG) variables readily available at admission. Methods: We included 590 reperfused STEMI patients who underwent early (1-week) and/or late (6-month) CMR in our institution. Baseline clinical, echocardiographic (left ventricular ejection fraction -LVEF-) and ECG data (summatory of ST-segment elevation -sum-STE- and Q-wave and residual ST-elevation >1 mm -Q-STE-) during admission were registered. Multivariate binary logistic regression models and receiver operating characteristic curves were computed for LVTh prediction. Results: LVTh was detected by CMR in 43 (7.3 %) patients and was predicted by previous chronic coronary syndrome (CCS, HR 4.74 [1.82-12.35], p = 0.001), anterior STEMI (HR 10.93 [2.47-48.31], p = 0.002), LVEF (HR 0.96 [0.93-0.99] per %, p = 0.008), maximum sum-STE (HR 1.04 [1.01-1.07] per mm, p = 0.04), and Q-STE (HR 1.31 [1.08-1.6] per lead, p = 0.008). High-risk patients with both major (anterior STEMI and Q-STE in >= 1 leads) and 1-3 minor (CCS, maximum sum-STE >10 mm, LVEF <50%) factors showed the highest LVTh risk (19.6 % within 6 months). The model showed excellent discrimination ability (area under the curve=0.85 [0.81-0.9], p < 0.001). Simplified 4-variable (excluding sum-STE) and 3-variable (also excluding CCS) risk scores showed similar discrimination ability and were externally validated. Conclusions: LVTh within 6 months post-STEMI can be predicted using pre-discharge clinical (anterior infarction and CCS), echocardiographic (LVEF), and ECG (sum-STE and Q-STE) data. Our results can help select patients who should undergo CMR after STEMI for LVTh detection.
Filiaciones:
Bertolin-Boronat C:
Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
INCLIVA Biomedical Research Institute, Valencia, Spain
Marcos-Garcés V:
Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
INCLIVA Biomedical Research Institute, Valencia, Spain
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
Merenciano-González H:
Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
INCLIVA Biomedical Research Institute, Valencia, Spain
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
Perez N:
INCLIVA Biomedical Research Institute, Valencia, Spain
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
Pérez Del Villar C:
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
Department of Cardiology, University Hospital of Salamanca, Salamanca, Spain
Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
Faculty of Medicine, University of Salamanca, Salamanca, Spain
Gavara J:
INCLIVA Biomedical Research Institute, Valencia, Spain
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain
Lopez-Lereu MP:
Cardiovascular Magnetic Resonance Unit, ASCIRES Biomedical Group, Valencia, Spain
Monmeneu JV:
Cardiovascular Magnetic Resonance Unit, ASCIRES Biomedical Group, Valencia, Spain
Herrera Flores C:
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
Department of Cardiology, University Hospital of Salamanca, Salamanca, Spain
Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
Domenech-Ximenos B:
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Cardiothoracic Imaging - Diagnostic Imaging Center, Hospital Clínic, Barcelona, Spain
López-Fornás FJ:
Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
Rios-Navarro C:
INCLIVA Biomedical Research Institute, Valencia, Spain
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
De Dios E:
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
Moratal D:
Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain
Ortiz-Pérez JT:
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
Bayes-Genis A:
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
Rodríguez-Palomares JF:
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
Vall d'Hebron Institut de Recerca, Barcelona, Spain
Nuñez J:
Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
INCLIVA Biomedical Research Institute, Valencia, Spain
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
Sánchez PL:
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
Department of Cardiology, University Hospital of Salamanca, Salamanca, Spain
Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
Faculty of Medicine, University of Salamanca, Salamanca, Spain
Sanchis J:
Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
INCLIVA Biomedical Research Institute, Valencia, Spain
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
Bodi V:
Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
INCLIVA Biomedical Research Institute, Valencia, Spain
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
Open Access
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