Abstract
Previous studies have reported left ventricular (LV) thrombus in 20% to 56% of patients
after anterior wall acute myocardial infarction (AMI). The Healing and Early Afterload
Reducing Therapy (HEART) study was a prospective study comparing effects of early
(24 hours) or delayed (14 days) initiation of ramipril, an angiotensin-converting
enzyme inhibitor, on LV function after anterior wall AMI. This ancillary study assessed
prevalence of LV thrombus. Two-dimensional echocardiography was performed on days
1, 14, and 90 after myocardial infarction. The cohort consisted of 309 patients. Q-wave
anterior wall AMI occurred in 78%; 87% received reperfusion therapy. The prevalence
of LV thrombus was 2 of 309 (0.6%) at day 1, 11 of 295 (3.7%) at day 14, and 7 of
283 (2.5%) at day 90. One patient had thrombus at 2 examinations. The day 1 echocardiogram
was not correlated with thrombus development. LV size increased more in patients with
thrombus than in those without thrombus. Patients with thrombus had more wall motion
abnormality after day 1 than patients without thrombus (p = 0.03). Thus, the current
prevalence of LV thrombus in anterior wall AMI is lower than previously reported,
possibly due to changes in AMI management. Preservation of LV function is likely to
be an important mechanism. Most thrombi are seen by 2 weeks after AMI. Resolution
documented by echocardiography is frequent.
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Article info
Publication history
Accepted:
April 15,
1997
Received in revised form:
April 15,
1997
Received:
November 13,
1996
Identification
Copyright
© 1997 Elsevier Science Inc. Published by Elsevier Inc. All rights reserved.
