Left ventricular thrombus formation after acute myocardial infarction as assessed by cardiovascular magnetic resonance imaging
Left ventricular thrombus formation after acute myocardial infarction as assessed by cardiovascular magnetic resonance imaging
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DOI：
10.1016/j.ejrad.2012.06.029
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发表时间：
2012-12-01
影响因子：
3.3
通讯作者：
Piek, Jan J.
中科院分区：
文献类型：
--
作者：
Delewi, Ronak;Nijveldt, Robin;Piek, Jan J.
引言：左心室（LV）血栓形成是心肌梗死（MI）的一种令人担忧的并发症。我们评估了经皮冠状动脉介入治疗（PCI）治疗的ST段抬高型心肌梗死患者中左室血栓的患病率，并比较了经胸超声心动图（TTE）与心血管磁共振成像（CMR）的诊断准确性。此外，我们评估了在现代时代的直接PCI的LV血栓的过程。方法：200例直接PCI患者进行了TTE和CMR，在基线和4个月的随访。研究由两名盲法检查员进行分析。患者在1，4，12和24个月的临床状态和不良事件的评估。结果：CMR在基线，血栓被发现在17 194（8.8%）例。15例患者的LV血栓消退。2例患者在随访CMR时持续存在LV血栓。在4个月的CMR中，在另外12名患者中发现血栓。在多变量分析中，基线CMR时的血栓形成与基线梗死面积（g）独立相关（B = 0.02，SE = 0.02，p < 0.001）。与CMR相比，常规TTE检测LV血栓的灵敏度为21-24%，特异性为95-98%。CMR检测左室血栓的观察者内和观察者间变异性（kappa = 0.91和kappa = 0.96）均低于TTE（kappa = 0.74和kappa = 0.53）。结论：PCI治疗后仍有相当数量的患者发生左室血栓，尤其是较大梗死面积的患者。常规TTE检测左室血栓的敏感性较低，观察者间TTE变异较大。(C)2012爱思唯尔爱尔兰有限公司保留所有权利。
Introduction: Left ventricular (LV) thrombus formation is a feared complication of myocardial infarction (MI). We assessed the prevalence of LV thrombus in ST-segment elevated MI patients treated with percutaneous coronary intervention (PCI) and compared the diagnostic accuracy of transthoracic echocardiography (TTE) to cardiovascular magnetic resonance imaging (CMR). Also, we evaluated the course of LV thrombi in the modern era of primary PCI.Methods: 200 patients with primary PCI underwent TTE and CMR, at baseline and at 4 months follow-up. Studies were analyzed by two blinded examiners. Patients were seen at 1, 4, 12, and 24 months for assessment of clinical status and adverse events.Results: On CMR at baseline, a thrombus was found in 17 of 194 (8.8%) patients. LV thrombus resolution occurred in 15 patients. Two patients had persistence of LV thrombus on follow-up CMR. On CMR at four months, a thrombus was found in an additional 12 patients. In multivariate analysis, thrombus formation on baseline CMR was independently associated with, baseline infarct size (g) (B = 0.02, SE = 0.02, p < 0.001). Routine TTE had a sensitivity of 21-24% and a specificity of 95-98% compared to CMR for the detection of LV thrombi. Intra-and interobserver variation for detection of LV thrombus were lower for CMR (kappa = 0.91 and kappa = 0.96) compared to TTE (kappa = 0.74 and kappa = 0.53).Conclusion: LV thrombus still occurs in a substantial amount of patients after PCI-treated MI, especially in larger infarct sizes. Routine TTE had a low sensitivity for the detection of LV thrombi and the interobserver variation of TTE was large. (C) 2012 Elsevier Ireland Ltd. All rights reserved.