Abstract 16357: Prevalence of Left Ventricular Thrombus (LVT) One Month Post Myocardial Infarction in Patients Discharged With Negative Inpatient Echocardiography - Incremental Utility of Delayed Enhancement Cardiac Magnetic Resonance (DE-CMR) Tissue Characterization
Background: DE-CMR is well validated for LVT but echocardiography (echo) is the predominant test used for screening. LVT prevalence 1 month post MI in patients with initial negative echo during MI hospitalization is unknown.
Methods: ST elevation MI patients with inpatient echo negative for LVT were prospectively enrolled. 1 month post MI, multimodality screening for LVT was performed via same day DE-CMR as well as both contrast (C) and non contrast (NC) echo - C was used in all patients without contraindication (96%). Each test (C, NC, DE-CMR) was independently read for LVT. LVT and MI size were quantified on DE-CMR.
Results: 192 patients were studied; all had echo (70% NC, 30% C) negative for LVT during hospitalization (3±2 days post MI). On followup (28±6 days), 8% (n=15) had LVT on DE-CMR, including 14% with LAD culprit vessel. Patients with LVT had lower EF (42±8 vs 55±11%, p<0.001) and larger infarct size (27±9 vs 14±10 %LV, p<0.001). All LVT were apically located; only 13% of patients with LVT had aneurysm by echo but all had apical infarct by DE-CMR. LVT was associated with apical infarct size (OR 1.3 per %LV [CI 1.1-1.5], p=0.002) independent of total LV infarction (OR 0.97 per %LV [CI 0.9-1.1], p=0.5). NC echo detected only 33% of LVT on DE-CMR. C echo improved sensitivity vs NC (Table) but was negative in 31% of cases with LVT on DE-CMR. For NC echo, performance varied based on image quality, with better quality for exams read for LVT concordant with DE-CMR (p=0.01). For C echo, results were independent of image quality (p=0.45), which was scored excellent in 91% of cases. Intracavitary LVT detected by both DE-CMR and C echo tended to be larger than those detected by DE-CMR alone (0.9±0.9 vs 0.2±0.03cm3, p=0.06).
Conclusions: LVT occurs 1 month post MI in nearly 10% of patients discharged with negative inpatient echo, commonly in those with apical MI but no aneurysm. Over 1/4 of post MI patients with LVT on DE-CMR have negative C echo, for which LVT detection varies in relation to LVT size.
Author Disclosures: J. Kim: None. R.B. Devereux: Research Grant; Modest; Lantheus Medical Imaging (Echo contrast manufacturer).. R.J. Kim: None. M. Petashnick: None. D. Veal: None. S. Gurevich: None. S. Alaref: None. F. Lin: None. Y. Wang: None. J.W. Weinsaft: Research Grant; Modest; Lantheus Medical Imaging (Echo contrast manufacturer)..
- © 2014 by American Heart Association, Inc.