Circulation, Vol 75, 1004-1011, Copyright © 1987 by American Heart Association
JR Stratton and AD Resnick
Although left ventricular thrombi are associated with an increased embolic
risk in the first few weeks after acute myocardial infarction, the
long-term risk remains undefined. To ascertain the incidence of strictly
defined systemic emboli, we followed 85 patients with echocardiographically
documented left ventricular thrombi. At the time of the entry
echocardiogram, most patients (n = 57) had remote myocardial infarction,
while 19 had recent (less than 1 month) infarction, and nine had idiopathic
cardiomyopathy. Because of the difficulty in classifying events as embolic
in patients with advanced atherosclerosis, a matched control group of 91
patients without thrombi was also studied. The thrombus and control groups
were similar with regard to recent myocardial infarction, remote
infarction, anterior infarction, ejection fraction, atrial fibrillation,
echocardiographic referral for source of emboli, and warfarin therapy.
During a mean follow-up of 22 months after echocardiography, embolic events
occurred in 13% (11 of 85) of patients with thrombi compared with 2% (two
of 91) control patients (p less than .01). The actuarial probability of
being embolus free at 2 years after echocardiography was 86% in patients
with thrombi compared with 97% in control patients (p less than .01). All
embolic events occurred greater than 1 month after myocardial infarction
(range 1 to 96 months). The only clinical or echocardiographic features
predictive of embolization were protrusion and mobility of thrombus (both p
less than .02). We conclude that the incidence of embolic events is
definitely increased in patients with left ventricular thrombi compared
with control subjects during long- term follow-up.(ABSTRACT TRUNCATED AT
250 WORDS)
ARTICLES
Increased embolic risk in patients with left ventricular thrombi
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