title: Thrombus formation in the left ventricle after large myocardial infarction – assessment with cardiac magnetic resonance imaging.
abstract: BACKGROUND
  Left ventricular thrombus (LVT) formation may worsen the post-infarct outcome as a result of thromboembolic events. It also complicates the use of modern antiplatelet regimens, which are not compatible with long-term oral anticoagulation. The knowledge of the incidence of LVT may therefore be of importance to guide antiplatelet and antithrombotic therapy after acute myocardial infarction (AMI).
  
  
  METHODS
  In 177 patients with large, mainly anterior AMI, standard cardiac magnetic resonance imaging (CMR) including cine and late gadolinium enhancement (LGE) imaging was performed shortly after AMI as per protocol. CMR images were analysed at an independent core laboratory blinded to the clinical data. Transthoracic echocardiography (TTE) was not mandatory for the trial, but was performed in 64% of the cases following standard of care. In a logistic model, 3 out of 61 parameters were used in a multivariable model to predict LVT.
  
  
  RESULTS
  LVT was detected by use of CMR in 6.2% (95% confidence interval [CI] 3.1%-10.8%). LGE sequences were best to detect LVT, which may be missed in cine sequences. We identified body mass index (odds ratio 1.18; p = 0.01), baseline platelet count (odds ratio 1.01, p = 0.01) and infarct size as assessed by use of CMR (odds ratio 1.03, p = 0.02) as best predictors for LVT. The agreement between TTE and CMR for the detection of LVT is substantial (kappa = 0.70).
  
  
  CONCLUSIONS
  In the current analysis, the incidence of LVT shortly after AMI is relatively low, even in a patient population at high risk. An optimal modality for LVT detection is LGE-CMR but TTE has an acceptable accuracy when LGE-CMR is not available.
authors.affiliation: Fondazione Cardiocentro Ticino, Lugano, Switzerland, and Department of Cardiology, Cardiovascular Centre, University Hospital Zurich, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Sürder
authors.affiliation: Department of Cardiology, Cardiovascular Centre, University Hospital Zurich, Switzerland.
authors.forename: Valentin
authors.initials: V
authors.lastname: Gisler
authors.affiliation: Department of Cardiology, Cardiovascular Centre, University Hospital Zurich, Switzerland, and Heart Clinic Hirslanden Zurich, Switzerland.
authors.forename: Roberto
authors.initials: R
authors.lastname: Corti
authors.affiliation: Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Tiziano
authors.initials: T
authors.lastname: Moccetti
authors.affiliation: IRCCS Fondazione Policlinico San Matteo, Servizio di Biometria e Statistica, Pavia, Italy.
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.affiliation: Department of Cardiology, Cantonal Hospital Lucerne, Switzerland, and Cardiology, St. Anna Clinic Hirslanden Lucerne, Switzerland.
authors.forename: Michel
authors.initials: M
authors.lastname: Zuber
authors.affiliation: Department of Cardiology, Bern University Hospital, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.affiliation: Department of Cardiology, Bern University Hospital, Switzerland.
authors.forename: Aris
authors.initials: A
authors.lastname: Moschovitis
authors.affiliation: Institute for Biomedical Engineering, University and ETH Zurich, Switzerland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kozerke
authors.affiliation: Department of Cardiology, Cardiovascular Centre, University Hospital Zurich, Switzerland.
authors.forename: Thomas Felix
authors.initials: TF
authors.lastname: Lüscher
authors.affiliation: Department of Cardiology, Cantonal Hospital Lucerne, Switzerland, and Heart Clinic Hirslanden Zurich, Switzerland.
authors.forename: Paul
authors.initials: P
authors.lastname: Erne
authors.affiliation: Department of Cardiology, Cardiovascular Centre, University Hospital Zurich, Switzerland, and Institute for Biomedical Engineering, University and ETH Zurich, Switzerland.
authors.forename: Robert
authors.initials: R
authors.lastname: Manka
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D015992:Body Mass Index; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009203:Myocardial Infarction / Q000150:complications*; D010976:Platelet Count; D011859:Radiography; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology*
chemical_list: D000925:Anticoagulants