Long-term clinical outcomes of the left ventricular thrombus in patients with ST elevation anterior myocardial infarction

BACKGROUND: This study was performed to determine the size of left ventricular thrombus (LVT), risk of systemic embolization and response to medical treatment during ۱۸ months of follow up in the patients with anterior-ST elevation myocardial infarction (aSTEMI). METHODS: This cross-sectional study was performed on thirty-five patients with anterior myocardial infarction (MI), in Emam Reza Hospital and Ghaem Hospital, Mashhad, Iran, from August ۲۰۰۸ to January ۲۰۱۱. Warfarin was prescribed for all the patients. Transthoracic echocardiographic study was performed on the ۱st, ۲nd, ۴th, ۶th, ۱۲th and ۱۸th months. Outcomes included rate of death, MI, stroke, systemic embolization, major bleeding and change in thrombus size following treatment. RESULTS: The resolve rate of clot on the ۲nd, ۴th, ۶th, ۱۲th and ۱۸th months was ۶۴.۷, ۸۶.۶, ۸۱.۴, ۸۱.۴ and ۱۰۰ percent, respectively. In five patients with complete clot resolution, clot reformation occurred after warfarin discontinuation. In these patients, left ventricular ejection fraction (LVEF) improvement was poor. During the study period, five patients died due to severe heart failure. One patient developed hematuria whereas non-experienced thromboembolic events. The mean LVEF at study initiation was ۳۰.۸ ± ۰.۹۲%, which improved to ۴۲ ± ۰.۸۴% (P < ۰.۰۵) at the end. CONCLUSION: All LVT was resolved with a combination therapy of antiplatelet and warfarin without any thromboembolic event. In patients with a poor improvement in the LV function, due to the risk of LVT reformation, lifelong warfarin therapy was recommended. 

Keywords:

Echocardiography , Left Ventricular Thrombosis , Myocardial Infarction