Title
Left ventricular thrombus after acute ST-segment elevation myocardial infarction: Multi-parametric cardiac magnetic resonance imaging with long-term outcomes
Author
Shi, Ruo yang (Shanghai Jiao Tong University)
Chen, Bing hua (Shanghai Jiao Tong University)
Wu, Chong wen (Shanghai Jiao Tong University)
Wesemann, Luke (Wayne State University)
Hu, Jiani (Wayne State University)
Xu, Jian rong (Shanghai Jiao Tong University)
Zhou, Yan (Shanghai Jiao Tong University)
Tao, Q. (TU Delft ImPhys/Medical Imaging; Leiden University Medical Center)
Wu, Lian ming (Shanghai Jiao Tong University)
Date
2022
Abstract
Left ventricular thrombus (LVT) after acute ST-segment elevation myocardial infarction (STEMI) are generally associated with poorer outcomes for patients at long-term follow-up. We hypothesis that tissue characteristics and strain parameters by cardiac magnetic resonance (CMR) imaging may indicate the interactions of LVT with ventricular myocardium remodeling at both acute stage and chronic stages in STEMI patients. This retrospective study included 111 consecutive STEMI patients (38 with LVT and 73 without LVT). All patients underwent CMR during acute stage (within 7 days) and chronic stage (after at least 2 months) periods after percutaneous coronary intervention (PCI). Left ventricular native T1, extracellular volume (ECV), radial, circumferential, and longitudinal strain were analyzed in both phases. Major adverse cardiac events (MACE, including cardiovascular death, myocardial reinfarction, and hospitalization for heart failure), thromboembolic and bleeding events, were the clinical endpoints of the study. During the acute stage, left ventricular ejection fraction (LVEF) (OR 0.77, P value = 0.01) and longitudinal strain (OR 1.90, P value < 0.001) were correlated with LVT formation. Strain parameters were reduced, while the native T1 and ECV values of both the infarcted area and remote myocardium were elevated in LVT patients. During the chronic stage, LVT resolved in 29 of 38 patients (76%). LVT remaining patients had lower LVEF, a larger LV, and higher ECV in the acute stage than those of the LVT-resolved patients. In the long-term follow up of 678 days, LVT (HR 2.45, P value = 0.02), aneurysm (HR 1.81, P value = 0.04), and native T1 (HR 2.44, P value = 0.01) were identified as three independent predictors of MACE, the incidence of thromboembolic events and bleeding events by a multivariable stepwise Cox proportional hazards regression. STEMI patients developing LVT had worse LV function, myocardial infarction extent, strain, and higher T1 and ECV values than STEMI patients without LVT. The LVT-remaining patients in the chronic stage had poorer functional and mapping parameters beginning in the first week. During the acute stage, LVEF and global longitudinal strain were independent correlated with LVT formation. During the long-term follow up, LVT, aneurysm and elevated myocardial T1 were associated with adverse outcomes in acute STEMI patients.
Subject
Extracellular volume
Left ventricular thrombus
Strain analysis
T1 map
To reference this document use:
http://resolver.tudelft.nl/uuid:ca0d07cd-62bc-4859-b98e-d8c62683327c
DOI
https://doi.org/10.1007/s10554-022-02598-9
Embargo date
2023-07-01
ISSN
1569-5794
Source
International Journal of Cardiovascular Imaging
Bibliographical note
Green Open Access added to TU Delft Institutional Repository 'You share, we take care!' - Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.
Part of collection
Institutional Repository
Document type
journal article
Rights
© 2022 Ruo yang Shi, Bing hua Chen, Chong wen Wu, Luke Wesemann, Jiani Hu, Jian rong Xu, Yan Zhou, Q. Tao, Lian ming Wu