Circulation, Vol 78, 1388-1393, Copyright © 1988 by American Heart Association
JR Stratton, JW Nemanich, KA Johannessen and AD Resnick
Although left ventricular thrombi that form acutely after myocardial
infarction frequently resolve spontaneously or with anticoagulant therapy,
the fate of left ventricular thrombi in patients with remote myocardial
infarction or with idiopathic cardiomyopathy remains unknown. To determine
the natural history of such chronic left ventricular thrombi, we performed
serial echocardiograms on 51 patients with remote myocardial infarction
(greater than or equal to 3 months; mean, 31 +/- 41 months) and on nine
patients with idiopathic dilated cardiomyopathy. Mean follow-up was 24 +/-
22 months during which 3.5 +/- 1.4 echocardiograms were obtained. Studies
were interpreted by blinded observers, and an increase or decrease of more
than 5 mm in maximal thrombus thickness was defined as significant. Among
all 60 patients left ventricular thrombi were unchanged in 24 (40%),
completely resolved in 24 (40%), decreased in size in four (7%), increased
in size in five (8%), and decreased and then increased in size in three
(5%). Results in patients with remote infarction and idiopathic
cardiomyopathy were similar. Warfarin therapy, which was at the discretion
of the primary physician, was associated with a higher prevalence of
thrombus resolution compared with no therapy (59% vs. 29%, p = 0.02).
Definite systemic emboli occurred in seven patients (12%), all at times
while they were not anticoagulated. Among the 48 thrombi that were present
on two or more echocardiograms, changes in thrombus shape (classified as
protruding or flat) occurred in only 16%, and changes in thrombus movement
(classified as mobile or immobile) occurred in only 10%.(ABSTRACT TRUNCATED
AT 250 WORDS)
ARTICLES
Fate of left ventricular thrombi in patients with remote myocardial infarction or idiopathic cardiomyopathy
Department of Medicine, Seattle VA Medical Center, Washington 98108.
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