title: Incidence, Outcomes, and Predictors of Ventricular Thrombus after Reperfused ST-Segment-Elevation Myocardial Infarction by Using Sequential Cardiac MR Imaging.
abstract: Purpose To characterize the incidence, outcomes, and predictors of left ventricular (LV) thrombus by using sequential cardiac magnetic resonance (MR) imaging after ST-segment-elevation myocardial infarction (STEMI). Materials and Methods Written informed consent was obtained from all patients, and the study protocol was approved by the committee on human research. In a cohort of 772 patients with STEMI, 392 (mean age, 58 years; range, 24-89 years) were retrospectively selected who were studied with cardiac MR imaging at 1 week and 6 months. Cardiac MR imaging guided the initiation and withdrawal of anticoagulants. Patients with LV thrombus at 6 months were restudied at 1 year. For predicting the occurrence of LV thrombus, a multiple regression model was applied. Results LV thrombus was detected in 27 of 392 patients (7%): 18 (5%) at 1 week and nine (2%) at 6 months. LV thrombus resolved in 22 of 25 patients (88%) restudied within the first year. During a mean follow-up of 181 weeks ± 168, patients with LV thrombus displayed a very low rate of stroke (0%), peripheral embolism (0%), and severe hemorrhage (n = 1, 3.7%). LV ejection fraction (LVEF) less than 50% (P < .001) and anterior infarction (P = .008) independently helped predict LV thrombus. The incidence of LV thrombus was as follows: (a) nonanterior infarction, LVEF 50% or greater (one of 135, 1%); (b) nonanterior infarction, LVEF less than 50% (one of 50, 2%); (c) anterior infarction, LVEF 50% or greater (two of 92, 2%); and (d) anterior infarction, LVEF less than 50% (23 of 115, 20%) (P < .001 for the trend). Conclusion Cardiac MR imaging contributes information for the diagnosis and therapy of LV thrombus after STEMI. Patients with simultaneous anterior infarction and LVEF less than 50% are at highest risk.©RSNA, 2017 Online supplemental material is available for this article.
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain (D.M.).
authors.forename: Esther
authors.initials: E
authors.lastname: Cambronero-Cortinas
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain (D.M.).
authors.forename: Clara
authors.initials: C
authors.lastname: Bonanad
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain (D.M.).
authors.forename: Jose V
authors.initials: JV
authors.lastname: Monmeneu
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain (D.M.).
authors.forename: María Pilar
authors.initials: MP
authors.lastname: Lopez-Lereu
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain (D.M.).
authors.forename: Jose
authors.initials: J
authors.lastname: Gavara
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain (D.M.).
authors.forename: Elena
authors.initials: E
authors.lastname: de Dios
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain (D.M.).
authors.forename: Cesar
authors.initials: C
authors.lastname: Rios
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain (D.M.).
authors.forename: Nerea
authors.initials: N
authors.lastname: Perez
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain (D.M.).
authors.forename: Paolo
authors.initials: P
authors.lastname: Racugno
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain (D.M.).
authors.forename: Ana
authors.initials: A
authors.lastname: Paya
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain (D.M.).
authors.forename: David
authors.initials: D
authors.lastname: Escribano
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain (D.M.).
authors.forename: Gema
authors.initials: G
authors.lastname: Minana
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain (D.M.).
authors.forename: Mauricio
authors.initials: M
authors.lastname: Pellicer
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain (D.M.).
authors.forename: Joaquim
authors.initials: J
authors.lastname: Cànoves
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain (D.M.).
authors.forename: Julio
authors.initials: J
authors.lastname: Nunez
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain (D.M.).
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Chorro
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain (D.M.).
authors.forename: David
authors.initials: D
authors.lastname: Moratal
authors.affiliation: From the Department of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de València, Blasco Ibañez 17, 46010 Valencia, Spain (E.C.C., C.B., J.G., E.d.D., C.R., N.P., P.R., A.P., D.E., G.M., M.P., J.C., J.N., F.J.C., V.B.); Cardiovascular Magnetic Resonance Unit, ERESA, Valencia, Spain (J.V.M., M.P.L.L.); and Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain (D.M.).
authors.forename: Vicente
authors.initials: V
authors.lastname: Bodi
mesh_terms: D000328:Adult; D000368:Aged; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging* / Q000628:therapy; D016896:Treatment Outcome