Timing and Detection of LV Thrombus After MI by MRI

Study Questions:

Does the timing of cardiac magnetic resonance imaging (CMR) after anterior ST-segment elevation myocardial infarction (STEMI) impact the detection rate of left ventricular (LV) thrombus?

Methods:

This study examined 265 patients with anterior STEMI, ≥10% necrosis of the LV, and CMR within 21 days, and evaluated risk factors for LV thrombus and compared the rate of LV thrombus detection by timing post-infarction.

Results:

All LV thrombi were in the apex, and all patients with LV thrombus had akinesis or dyskinesis of the apex. Rates of LV thrombi were lower in patients with early versus later (≤5 vs. >5 days) imaging (13/160 vs. 21/105; p = 0.0047), with the highest rates of thrombi noted between 9 and 12 days post-infarction.

Conclusions:

Patients with CMR performed >5 days after anterior STEMI had higher rates of LV thrombi than patients with earlier CMR.

Perspective:

This study suggests that early CMR after anterior STEMI may miss some patients who could develop subsequent LV thrombus. However, the difference was barely statistically significant, and it is unclear whether other clinical variables that may have impacted CMR timing could be related to these differences. Definitive assessment of the optimal timing for CMR to detect LV thrombus after anterior STEMI requires a study with serial imaging in the same patients.

Clinical Topics: Acute Coronary Syndromes, Noninvasive Imaging, Magnetic Resonance Imaging

Keywords: Acute Coronary Syndrome, Anterior Wall Myocardial Infarction, Diagnostic Imaging, Magnetic Resonance Imaging, Myocardial Infarction, Risk Factors, Thrombosis


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