Author + information
- Received September 29, 1988
- Revision received December 7, 1988
- Accepted December 16, 1988
- Published online June 1, 1989.
- Albert J. Funke Küpper, MD∗,
- Freek W.A. Verheugt, MD, FACC,
- Cathinka H. Peels, MD,
- Tjebbe W. Galema, MD and
- Jan P. Roos, MD
- ↵∗Address for reprints: Albert J. Funke Küpper, MD, Department of Cardiology, Free University Hospital, De Boelelaan 1117, 1007 MB Amsterdam, The Netherlands.
Serial two-dimensional echocardiography was performed to detect left ventricular thrombus in 92 consecutive patients with a confirmed first acute anterior myocardial infarction. Thirty left ventricular thrombi were diagnosed in these 92 patients. The cumulative percent of identified thrombus in each echocardiographic examination in the surviving patients was 27% at <24 h; 57% at 48 to 72 h; 75% at 1 week and 96% at 2 weeks. The thrombus shape was defined as mural in 53% and protruding in 47% of patients. Systemic embolism (stroke) was noted during hospitalization in two patients with a protruding thrombus.
At 12 weeks of follow-up, patients with thrombus had poorer (and almost unchanged from baseline) global left ventricular function as expressed by wall motion score compared with that of patients without thrombus, who exhibited significant improvement. Global left ventricular wall motion in patients with persisting or resolved thrombus was similar during follow-up. Apical wall motion worsened in 70% of the patients with persisting thrombus and in 25% of the patients with resolved thrombus (p < 0.1). In the 22 surviving patients with thrombus, resolution or change in thrombus shape or size was noted in 14 of the 15 patients receiving anticoagulant therapy and in 4 of the 7 untreated patients. Six of the 18 patients with an early- (48 to 72 h) and none of the 12 patients with a later-formed thrombus died. Maximal serum enzyme levels, percent with Killip functional class III to IV and left ventricular wall motion score were higher in the patients with an early- than in those with a later-formed thrombus.
Thus, left ventricular thrombus was found in 33% of patients with a first anterior myocardial infarction. Thrombus formation within 48 to 72 h was associated with a poor prognosis. Two-dimensional echocardiography performed the 3rd day and after 2 weeks had the most clinical value in assessing early prognosis and identifying left ventricular thrombus. The presence or absence of thrombus was strongly correlated with a change in left ventricular function during follow-up. In patients treated with oral anticoagulant agents, 93% of the left ventricular thrombi showed resolution or change in size or shape.
☆ This study was supported in part by Grant 85.048 from the Dutch Heart Foundation, Den Haag, The Netherlands.
- Received September 29, 1988.
- Revision received December 7, 1988.
- Accepted December 16, 1988.