title: Left ventricular thrombus formation after acute myocardial infarction as assessed by cardiovascular magnetic resonance imaging.
abstract: BACKGROUND
  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 (κ=0.91 and κ=0.96) compared to TTE (κ=0.74 and κ=0.53).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Ronak
authors.initials: R
authors.lastname: Delewi
authors.forename: Robin
authors.initials: R
authors.lastname: Nijveldt
authors.forename: Alexander
authors.initials: A
authors.lastname: Hirsch
authors.forename: Constantin B
authors.initials: CB
authors.lastname: Marcu
authors.forename: Lourens
authors.initials: L
authors.lastname: Robbers
authors.forename: Marriela E C J
authors.initials: ME
authors.lastname: Hassell
authors.forename: Rianne H A
authors.initials: RH
authors.lastname: de Bruin
authors.forename: Jim
authors.initials: J
authors.lastname: Vleugels
authors.forename: Anja M
authors.initials: AM
authors.lastname: van der Laan
authors.forename: Berto J
authors.initials: BJ
authors.lastname: Bouma
authors.forename: René A
authors.initials: RA
authors.lastname: Tio
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Albert C
authors.initials: AC
authors.lastname: van Rossum
authors.forename: Felix
authors.initials: F
authors.lastname: Zijlstra
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Piek
mesh_terms: D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000473:pathology* / Q000601:surgery; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013927:Thrombosis / Q000209:etiology* / Q000473:pathology* / Q000517:prevention & control; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000473:pathology* / Q000517:prevention & control