Study on risk factors for left ventricular thrombosis after first acute anterior wall myocardial infarction
Abstract
Objective: Left ventricular thrombosis is one of the complications of acute myocardial infarction, and the high-risk factors in first acute anterior myocardial infarction have not been fully elucidated. This study aimed to explore the risk factors for left ventricular thrombosis in patients with their first acute anterior myocardial infarction. Methods: We retrospectively analyzed the clinical data of 84 patients diagnosed with their first acute anterior myocardial infarction in the Department of Cardiovascular Medicine, Gulou Clinical College, Xuzhou Medical University, from March 2019 to June 2023 and divided them into a thrombosis group (left ventricular thrombosis, n = 35) and a control group (no left ventricular thrombosis, n = 49) according to the presence or absence of left ventricular thrombosis. The baseline data and imaging characteristics of the two groups of patients were retrospectively analyzed. Univariate and multivariate logistic regression analysis was used to evaluate the risk factors for left ventricular thrombosis. Results: In univariate analysis, female sex, diabetes, hypercholesterolemia, ALT, AST, CRP, NT-ProBNP, D-dimer, CKMB peak, cTnI, LVEF, and WMS (wall motion score 1–5) were significantly associated with left ventricular thrombosis (P < 0.05). Multivariate analysis showed that female sex, diabetes, hypercholesterolemia, ALT, AST, CRP, NT-ProBNP, D-dimer and WMS (wall motion score 1–5) were independent risk factors for left ventricular thrombosis (P < 0.05). Based on the analysis of hemodynamic characteristics, left ventricular segmental systolic dysfunction after anterior wall myocardial infarction leads to changes in the velocity gradient of intraventricular blood flow, local blood flow stasis, and abnormal shear stress. This is especially true in patients with significantly reduced LVEF (< 40%) and wall motion scores ≥ 3. The vortexes formed by changes in ventricular geometry, together with endothelial injury, jointly constitute the physical basis for thrombosis formation. Conclusion: This study found that gender, diabetes, hypercholesterolemia/lipidemia, inflammatory markers (such as CRP), myocardial injury markers (such as NT-ProBNP, CKMB, cTnI), thrombosis markers (such as D-dimer), and left ventricular dysfunction were closely associated with left ventricular thrombosis after the first acute anterior wall myocardial infarction. These results help to better understand the pathogenesis of left ventricular thrombosis after myocardial infarction and provide important clues for early prevention and intervention.
References
1. Zhang Y. Investigation and study on the incidence and risk factors of left ventricular mural thrombus after acute myocardial infarction [Master’s thesis]. Peking Union Medical College; 2019.
2. Zhang Y, Zhao H, Sheng Z, et al. Investigation on the incidence and risk factors of left ventricular mural thrombus in acute ST-segment elevation myocardial infarction. Chinese Journal of Interventional Cardiology. 2020; 28(01): 16-20.
3. Habash F, Vallurupalli S. Challenges in management of left ventricular thrombus. Therapeutic Advances in Cardiovascular Disease. 2017; 11(8): 203-213. doi: 10.1177/1753944717711139
4. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart Journal. 2017; 39(2): 119-177. doi: 10.1093/eurheartj/ehx393
5. Tang H, Zhu Z, Yang S. Clinical characteristics and related factors of hospitalized patients with acute ST-segment elevation myocardial infarction complicated with left ventricular mural thrombus (Chinese). Chinese Journal of Medical Engineering. 2024; 32(03): 107-110. doi: 10.19338/j.issn.1672-2019.2024.03.020
6. Toyoda K, Yasaka M, Iwade K, et al. Dual Antithrombotic Therapy Increases Severe Bleeding Events in Patients With Stroke and Cardiovascular Disease. Stroke. 2008; 39(6): 1740-1745. doi: 10.1161/strokeaha.107.504993
7. McCarthy CP, Vaduganathan M, McCarthy KJ, et al. Left Ventricular Thrombus After Acute Myocardial Infarction. JAMA Cardiology. 2018; 3(7): 642. doi: 10.1001/jamacardio.2018.1086
8. Khanna S, Bhat A, Mardini M, et al. Left ventricular aneurysm: a rare complication of an acute myocardial infarction in the modern era. Oxford Medical Case Reports. 2020; 2020(9). doi: 10.1093/omcr/omaa080
9. Meurin P, Brandao Carreira V, Dumaine R, et al. 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. American Heart Journal. 2015; 170(2): 256-262. doi: 10.1016/j.ahj.2015.04.029
10. Cruz Rodriguez JB, Okajima K, Greenberg BH. Management of left ventricular thrombus: a narrative review. Annals of Translational Medicine. 2021; 9(6): 520. doi: 10.21037/atm-20-7839
11. Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. European Heart Journal. 2023; 44(38): 3720-3826. doi: 10.1093/eurheartj/ehad191
12. Okuyan E, Okcun B, Dinçkal MH, et al. Risk factors for development of left ventricular thrombus after first acute anterior myocardial infarction-association with anticardiolipin antibodies. Thrombosis Journal. 2010; 8(1): 15. doi: 10.1186/1477-9560-8-15
13. Guo C, Yang L, Huo Z, et al. Effect of alcohol consumption on left atrial appendage thrombosis in patients with non-valvular atrial fibrillation (Chinese). Chinese Journal of Interventional Cardiology. 2021; 29(8): 442-446.
14. Lü X, Li S, Li W, et al. Screening of risk factors for long-term adverse cardiovascular events in patients with acute non-ST-segment elevation myocardial infarction and construction of a predictive scoring system (Chinese). Chinese Journal of General Practice. 2021; 24(35): 4457-4462.
15. Guo Y, Zhao X, Wang L, et al. Analysis of related factors of early left ventricular aneurysm combined with left ventricular thrombus in patients with acute STEMI (Chinese). Chinese Journal of Cardiology. 2021; 49(4): 360-367.
16. Chen X, Wang L, Ding C. Factors affecting early left ventricular thrombosis after emergency PCI in STEMI patients (Chinese). Journal of Integrated Traditional Chinese and Western Medicine for Cardiovascular and Cerebrovascular Diseases. 2022; 20(14): 2612-2615.
17. Takasugi J, Yamagami H, Noguchi T, et al. Detection of Left Ventricular Thrombus by Cardiac Magnetic Resonance in Embolic Stroke of Undetermined Source. Stroke. 2017; 48(9): 2434-2440. doi: 10.1161/strokeaha.117.018263
18. Cannon CP, Bhatt DL, Oldgren J, et al. Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation. New England Journal of Medicine. 2017; 377(16): 1513-1524. doi: 10.1056/nejmoa1708454
19. Zhai S. Analysis of related factors of left ventricular mural thrombus in patients with acute ST-segment elevation myocardial infarction [Master’s thesis]. Hefei: Anhui Medical University; 2021.
20. Xu W, Shi Y, Meng X, et al. Efficacy of combined use of recombinant human brain natriuretic peptide and sacubitril-valsartan in patients with acute myocardial infarction and acute heart failure and serum galectin-3 and pentraxin-3 levels (Chinese). World Clinical Drugs. 2021; 42(5): 381-387.
21. Ali-Barman H, Atici A, Erturk E, et al. Apical longitudinal strain can help predict the development of left ventricular thrombus after anterior myocardial infarction. Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion. 2020; 72(6): 353-362. doi: 10.24875/RIC.20000027
22. Duan P, Lu S, Zhang X, et al. Analysis of risk factors for acute ST-segment elevation myocardial infarction with left ventricular thrombosis (Chinese). Journal of Clinical Cardiology. 2016; 32(3): 251-254.
23. Yu Y, Chen H, Zhang H, et al. Factors affecting the risk of left ventricular thrombus in high-risk patients with acute ST-segment elevation myocardial infarction (Chinese). Chinese Journal of Evidence-Based Cardiovascular Medicine. 2022; 14(12): 1492-1496.
24. Bravo Baptista S, Faustino M, Brizida L, et al. Early peripheral endothelial dysfunction predicts myocardial infarct extension and microvascular obstruction in patients with ST-elevation myocardial infarction. Revista Portuguesa de Cardiologia (English Edition). 2017; 36(10): 731-742. doi: 10.1016/j.repce.2017.01.007
25. Galli M, Niccoli G, De Maria G, et al. Coronary microvascular obstruction and dysfunction in patients with acute myocardial infarction. Nature Reviews Cardiology. 2023; 21(5): 283-298. doi: 10.1038/s41569-023-00953-4
26. Konijnenberg LSF, Damman P, Duncker DJ, et al. Pathophysiology and diagnosis of coronary microvascular dysfunction in ST-elevation myocardial infarction. Cardiovascular Research. 2019; 116(4): 787-805. doi: 10.1093/cvr/cvz301
27. Diamond SL. Systems Analysis of Thrombus Formation. Circulation Research. 2016; 118(9): 1348-1362. doi: 10.1161/circresaha.115.306824
28. Klein MD, Herman MV, Gorlin R, et al. A Hemodynamic Study of Left Ventricular Aneurysm. Circulation. 1967; 35(4): 614-630. doi: 10.1161/01.cir.35.4.614
29. de Gregorio C, Grimaldi P, Lentini C. Left ventricular thrombus formation and cardioembolic complications in patients with Takotsubo-like syndrome: A systematic review. International Journal of Cardiology. 2008; 131(1): 18-24. doi: 10.1016/j.ijcard.2008.05.060
Copyright (c) 2025 Author(s)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright on all articles published in this journal is retained by the author(s), while the author(s) grant the publisher as the original publisher to publish the article.
Articles published in this journal are licensed under a Creative Commons Attribution 4.0 International, which means they can be shared, adapted and distributed provided that the original published version is cited.
Submit a Paper
