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Left ventricular thrombus after acute ST-segment elevation myocardial infarction: multi-parametric cardiac magnetic resonance imaging with long-term outcomes

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Abstract

Left ventricular thrombus (LVT) after acute ST-segment elevation myocardial infarction (STEMI) are generally associated with poorer outcomes for patients at long-term follow-up. We hypothesis that tissue characteristics and strain parameters by cardiac magnetic resonance (CMR) imaging may indicate the interactions of LVT with ventricular myocardium remodeling at both acute stage and chronic stages in STEMI patients. This retrospective study included 111 consecutive STEMI patients (38 with LVT and 73 without LVT). All patients underwent CMR during acute stage (within 7 days) and chronic stage (after at least 2 months) periods after percutaneous coronary intervention (PCI). Left ventricular native T1, extracellular volume (ECV), radial, circumferential, and longitudinal strain were analyzed in both phases. Major adverse cardiac events (MACE, including cardiovascular death, myocardial reinfarction, and hospitalization for heart failure), thromboembolic and bleeding events, were the clinical endpoints of the study. During the acute stage, left ventricular ejection fraction (LVEF) (OR 0.77, P value = 0.01) and longitudinal strain (OR 1.90, P value < 0.001) were correlated with LVT formation. Strain parameters were reduced, while the native T1 and ECV values of both the infarcted area and remote myocardium were elevated in LVT patients. During the chronic stage, LVT resolved in 29 of 38 patients (76%). LVT remaining patients had lower LVEF, a larger LV, and higher ECV in the acute stage than those of the LVT-resolved patients. In the long-term follow up of 678 days, LVT (HR 2.45, P value = 0.02), aneurysm (HR 1.81, P value = 0.04), and native T1 (HR 2.44, P value = 0.01) were identified as three independent predictors of MACE, the incidence of thromboembolic events and bleeding events by a multivariable stepwise Cox proportional hazards regression. STEMI patients developing LVT had worse LV function, myocardial infarction extent, strain, and higher T1 and ECV values than STEMI patients without LVT. The LVT-remaining patients in the chronic stage had poorer functional and mapping parameters beginning in the first week. During the acute stage, LVEF and global longitudinal strain were independent correlated with LVT formation. During the long-term follow up, LVT, aneurysm and elevated myocardial T1 were associated with adverse outcomes in acute STEMI patients.

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Abbreviations

CMR:

Cardiac magnetic resonance

MACE:

Major adverse cardiac events

LVT:

Left ventricular thrombus

LAD:

Left anterior descending

LGE:

Late gadolinium enhancement

LVEF:

Left ventricular ejection fraction

LVEDVi:

Left ventricular end-diastolic volume index

LVESVi:

Left ventricular end-systolic volume index

LVMi:

Left ventricular mass index

GRS:

Global radial strain

GLS:

Global longitudinal strain

GCS:

Global circumferential strain

ECV:

Extracellar volume

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Acknowledgements

Ruo-yang Shi, Bing-hua Chen, and Chong-wen Wu contributed equally to this work. Yan Zhou, Qian Tao and Lian-ming Wu are the corresponding authors for this article.

Funding

This work was supported by the following grants: National Natural Science Foundation of China (Grant Nos. 81873886, 81873887, 8217188); National Natural Science Foundation of China Youth Project (Grant No. 82101981); Shanghai Shenkang Hospital Development Center Clinical Research and Cultivation Project (Grant No. SHDC12018X21); Shanghai Science and technology innovation action plan, technology standard project (Grant No. 19DZ2203800); Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant; Shanghai Jiao Tong University school of medicine Double hundred outstanding person project (Grant No. 20191904); Shanghai Sailing Program (Grant No. 22YF1438600); Shanghai Jiao Tong University Medical Engineering cross fund (Grant Nos. YG2022QN016, YG2022QN020, YG2022QN028).

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Authors and Affiliations

  1. Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Shanghai, China

    Ruo-yang Shi, Bing-hua Chen, Chong-wen Wu, Jian-rong Xu, Yan Zhou & Lian-ming Wu

  2. Department of Radiology, Wayne State University, Detroit, MI, USA

    Luke Wesemann & Jiani Hu

  3. Department of Imaging Physics, Delft University of Technology, Lorentzweg 1, 2628 CJ, Delft, The Netherlands

    Qian Tao

  4. Division of Imaging Processing, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands

    Qian Tao

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  1. Ruo-yang Shi
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  2. Bing-hua Chen
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Correspondence to Yan Zhou, Qian Tao or Lian-ming Wu.

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Shi, Ry., Chen, Bh., Wu, Cw. et al. Left ventricular thrombus after acute ST-segment elevation myocardial infarction: multi-parametric cardiac magnetic resonance imaging with long-term outcomes. Int J Cardiovasc Imaging 38, 2373–2384 (2022). https://doi.org/10.1007/s10554-022-02598-9

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