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document
Relation between early mitral regurgitation and left ventricular thrombus formation after acute myocardial infarction : results of the GISSI-3 echo substudy . OBJECTIVE To evaluate the prevalence and correlates of left ventricular thrombosis in patients with acute myocardial infarction , and whether the occurrence of early mitral regurgitation has a protective effect against the formation of left ventricular thrombus . DESIGN AND SETTING Multicentre clinical trial carried out in 47 Italian coronary care units . PATIENTS AND METHODS 757 patients from the GISSI-3 echo substudy population with their first acute myocardial infarct were studied by echocardiography at 24-48 hours from symptom onset ( S1 ) , at discharge ( S2 ) , at six weeks ( S3 ) , and at six months ( S4 ) . The diagnosis of left ventricular thrombosis was based on the detection of an echo dense mass with defined margins visible throughout the cardiac cycle in at least two orthogonal views . RESULTS In 64 patients ( 8 % ) , left ventricular thrombosis was detected in one or more examinations . Compared with the remaining 693 patients , subjects with left ventricular thrombosis were older ( mean ( SD ) age : 64.6 ( 13.0 ) v 59.8 ( 11.7 ) years , p < 0.005 ) , and had larger infarcts ( extent of wall motion asynergy : 40.9 ( 11.5 ) % v 24.9 ( 14 ) % , p < 0.001 ) , greater depression of left ventricular ejection fraction at S1 ( 43.3 ( 6.9 ) % v 48.1 ( 6.8 ) % , p < 0.001 ) , and greater left ventricular volumes at S1 ( end diastolic volume : 87 ( 22 ) v 78 ( 18 ) ml/m ( 2 ) , p < 0.001 ; end systolic volume : 50 ( 17 ) v 41 ( 14 ) ml/m ( 2 ) , p < 0.001 ) . The prevalence of moderate to severe mitral regurgitation on colour Doppler at S1 was greater in patients who had left ventricular thrombosis at any time ( 10.2 % v 4.2 % , p < 0.05 ) . On stepwise multiple logistic regression analysis the only independent variables related to the presence of left ventricular thrombosis were the extent of wall motion asynergy and anterior site of infarction . CONCLUSIONS Left ventricular thrombosis is not reduced , and may even be increased , by early moderate to severe mitral regurgitation after acute myocardial infarction . The only independent determinant of left ventricular thrombosis is the extent of the akinetic-dyskinetic area detected on echocardiography between 24-48 hours from symptom onset .
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Intervention_Physical
echocardiography at 24-48 hours from symptom onset
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Outcome_Physical
left ventricular thrombosis
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Outcome_Physical
left ventricular thrombosis
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Outcome_Physical
larger infarcts
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Outcome_Physical
depression of left ventricular ejection fraction at S1
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Outcome_Physical
left ventricular volumes at S1
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Outcome_Physical
prevalence of moderate to severe mitral regurgitation on colour Doppler at S1
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Outcome_Physical
left ventricular thrombosis
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Outcome_Physical
left ventricular thrombosis
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Outcome_Physical
Left ventricular thrombosis