title: Incidence, diagnostic methods, and evolution of left ventricular thrombus in patients with anterior myocardial infarction and low left ventricular ejection fraction: a prospective multicenter study.
abstract: OBJECTIVE
  We aimed to assess the incidence and evolution of left ventricular (LV) thrombi in a high-risk population of patients with LV systolic dysfunction after anterior myocardial infarction (ant-MI). We also compared the accuracy of transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging with contrast-delayed enhancement (CMR-DE) in detecting LV thrombi.
  
  
  METHODS
  We prospectively included 100 consecutive patients with LV ejection fraction (LVEF) <45% at the first TTE performed <7 days after ant-MI. A second evaluation with TTE and CMR-DE (by blinded examiners) was performed at 30 days. A third TTE and assessment of clinical status were performed between 6 and 12 months after ant-MI.
  
  
  RESULTS
  Patients (males 71%; mean age 59.1 ± 12.1 years; mean LVEF 33.5% ± 6.0%) were included at a median of 5.5 days (interquartile range 25th-75th percentile 4.25-6.0 days) after ant-MI. Thrombi were detected among 26 (26%) patients at a median of 12.0 days after ant-MI (7 patients at 1-7 days after MI; 15 at 8-30 days; and 4 after day 30). Sensitivity and specificity for LV thrombi detection were 94.7% and 98.5%, respectively, for TTE as compared with CMR-DE. Most thrombi (n = 24; 92.3%) disappeared after triple antithrombotic therapy (vitamin K antagonist in addition to dual antiplatelet therapy).
  
  
  CONCLUSIONS
  Left ventricular thrombus is a frequent complication after ant-MI with systolic dysfunction. When a search for thrombus is prespecified, the accuracy of TTE is high as compared with CMR-DE. The best antithrombotic strategy is not known.
authors: Centre de Réadaptation cardiaque de la Brie Les Grands Prés, 27 rue Sainte Christine, Villeneuve Saint Denis, France. Electronic address: philippemeurin@hotmail.com.
authors: Philippe
authors: P
authors: Meurin
authors: Marne La Vallée Hospital, 4 cours de Gondoire, Jossigny, France.
authors: Virginie
authors: V
authors: Brandao Carreira
authors: Centre de Réadaptation cardiaque de la Brie Les Grands Prés, 27 rue Sainte Christine, Villeneuve Saint Denis, France.
authors: Raphaelle
authors: R
authors: Dumaine
authors: College National des Cardiologues Français and Cabinet Médical, Esbly, France.
authors: Alain
authors: A
authors: Shqueir
authors: Le Raincy-Montfermeil Hospital, 10 rue du Général Leclerc Montfermeil, France; Collège National des Cardiologues des Hôpitaux Français.
authors: Olivier
authors: O
authors: Milleron
authors: Le Raincy-Montfermeil Hospital, 10 rue du Général Leclerc Montfermeil, France; Collège National des Cardiologues des Hôpitaux Français.
authors: Benjamin
authors: B
authors: Safar
authors: Meaux Hospital, 6 rue Saint Fiacre, Meaux, France.
authors: Sergio
authors: S
authors: Perna
authors: Tournan Clinic, 2 rue Jules Lefebvre, Tournan en Brie, France.
authors: Charles
authors: C
authors: Smadja
authors: Léon Binet Hospital, route Chalautre, Provins, France.
authors: Marc
authors: M
authors: Genest
authors: Private Hospital Jacques Cartier, CMR Department, Institut Cardiovasculaire Paris Sud-ICPS, Générale de Santé, 6 Ave du Noyer Lambert, Massy, France.
authors: Jérome
authors: J
authors: Garot
authors: Courlancy Clinic, 38 rue Courlancy, Reims, France.
authors: Bernard
authors: B
authors: Carette
authors: André Grégoire Hospital, 56 Boulevard de la Boissière, Montreuil sous bois, France.
authors: Laurent
authors: L
authors: Payot
authors: Centre de Réadaptation cardiaque de la Brie Les Grands Prés, 27 rue Sainte Christine, Villeneuve Saint Denis, France; Private Hospital Jacques Cartier, CMR Department, Institut Cardiovasculaire Paris Sud-ICPS, Générale de Santé, 6 Ave du Noyer Lambert, Massy, France.
authors: Jean Yves
authors: JY
authors: Tabet
mesh_terms: D056988:Anterior Wall Myocardial Infarction / Q000150:complications* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006331:Heart Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D006352:Heart Ventricles; D006801:Humans; D015994:Incidence; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology*; D013927:Thrombosis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D016277:Ventricular Function, Left / Q000502:physiology*