Frequency of Left Ventricular Thrombus at 72 Hours in Patients Presenting with Acute Anterior Wall Myocardial Infarction at Peshawar Institute of Cardiology
DOI:
https://doi.org/10.61919/ky3m2379Keywords:
Left ventricular thrombus, anterior wall myocardial infarction, echocardiography, diabetes mellitus, smoking, ejection fraction, PakistanAbstract
Background: Left ventricular thrombus (LVT) is a well-recognized complication of acute anterior wall myocardial infarction (AWMI), associated with an elevated risk of embolic events. While international data suggest an LVT incidence ranging from 5% to 38% depending on population and imaging modality, there is limited evidence from South Asian populations, where cardiovascular risk profiles and healthcare delivery contexts differ substantially. Objective: To determine the frequency of LVT formation at 72 hours post-admission and identify associated clinical and echocardiographic risk factors in patients presenting with AWMI at the Peshawar Institute of Cardiology. Methods: This cross-sectional observational study included 278 adult patients with AWMI admitted within 24 hours of symptom onset between December 1, 2024, and May 31, 2025. Consecutive sampling was employed. Echocardiography was performed at admission and repeated at 72 hours to detect LVT. Demographic, clinical, and echocardiographic data were analyzed using SPSS v23.0, with multivariate logistic regression employed to identify independent predictors. Results: LVT was identified in 17.3% (48/278) of patients, predominantly at the left ventricular apex (87.5%). Independent predictors of LVT included reduced left ventricular ejection fraction (OR: 1.12 per 1% decrease; p<0.001), anterior wall akinesia (OR: 7.94; p=0.005), diabetes mellitus (OR: 2.19; p=0.032), smoking (OR: 2.02; p=0.044), and higher troponin I levels (OR: 1.09 per ng/mL; p=0.034). All embolic complications and in-hospital deaths occurred among patients with LVT. Conclusion: Approximately one in six patients with AWMI develops LVT within 72 hours, with clear clinical and echocardiographic predictors identifying a high-risk subgroup. Routine echocardiographic screening should be considered in these patients to enable early anticoagulation and prevent embolic complications.
References
1. Niazi AK, Kassem H, Shalaby G, Khaled S, Alzahrani MS, Ali HM, et al. Frequency and predictors of left ventricular thrombus after ST-elevation myocardial infarction in the Holy Capital of Saudi Arabia. J Saudi Heart Assoc. 2021;33(2):101–8.
2. Khaled S, Hachicha Z, Elkhateeb O. Left ventricular thrombus in myocardial infarction after successful primary percutaneous coronary intervention: prevalence and predictors—a Middle Eastern single-centre experience. CJC Open. 2020;2(3):104–10.
3. Boivin-Proulx LA, Ieroncig F, Demers SP, Nozza A, Soltani M, Ghersi I, et al. Contemporary frequency and predictors of left ventricular thrombus in patients with anterior acute myocardial infarction. Clin Res Cardiol. 2023;112(4):558–67.
4. Aljaber NN, Mattash ZA, Alshoabi SA, Alhazmi FH. The prevalence of left ventricular thrombus among patients with low ejection fraction by transthoracic echocardiography. Pak J Med Sci. 2020;36(4):673–7.
5. Camaj A, Fuster V, Giustino G, Bienstock SW, Sternheim D, Mehran R, et al. Left ventricular thrombus following acute myocardial infarction: JACC state-of-the-art review. J Am Coll Cardiol. 2022;79(10):1010–22.
6. Habash F, Vallurupalli S. Challenges in management of left ventricular thrombus. Ther Adv Cardiovasc Dis. 2017;11(8):203–13.
7. Meurin P, Brandao Carreira V, Dumaine R, Shqueir A, Millaire A, Tricot O, et al. Incidence, diagnostic methods, and evolution of left ventricular thrombus in patients with anterior myocardial infarction and low left ventricular ejection fraction: a prospective multicenter study. Am Heart J. 2015;170(2):256–62.
8. Phan J, Nguyen T, French J, Moses D, Schlaphoff G, Lo S, et al. Frequency and predictors of left ventricular thrombus formation following acute ST-segment elevation myocardial infarction: a serial cardiac MRI study. Int J Cardiol Heart Vasc. 2019;24:100395.
9. Bulluck H, Chan MHH, Paradies V, Yellon RL, Ho HH, Chan MY, et al. Incidence and predictors of left ventricular thrombus by cardiovascular magnetic resonance in acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: a meta-analysis. J Cardiovasc Magn Reson. 2018;20(1):72.
10. Delewi R, Zijlstra F, Piek JJ. Left ventricular thrombus formation after acute myocardial infarction. Heart. 2012;98(23):1743–9.
11. Solheim S, Seljeflot I, Lunde K, Bjørnerheim R, Aakhus S, Forfang K, et al. Frequency of left ventricular thrombus in patients with anterior wall acute myocardial infarction treated with percutaneous coronary intervention and dual antiplatelet therapy. Am J Cardiol. 2010;106(9):1197–201.
12. Vinik AI, Erbas T, Park TS, Nolan R, Pittenger GL. Platelet dysfunction in type 2 diabetes. Diabetes Care. 2001;24(8):1476–85.
13. Benowitz NL, Fitzgerald GA, Wilson M, Zhang Q. Nicotine effects on eicosanoid formation and hemostatic function: comparison of transdermal nicotine and cigarette smoking. J Am Coll Cardiol. 1993;22(4):1159–67.
14. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233–70.
15. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–4.
16. Camaj A, Fuster V, Giustino G, Bienstock SW, Sternheim D, Mehran R, et al. Left ventricular thrombus following acute myocardial infarction: JACC state-of-the-art review. J Am Coll Cardiol. 2022;79(10):1010–22.
17. Delewi R, Zijlstra F, Piek JJ. Left ventricular thrombus formation after acute myocardial infarction. Heart. 2012;98(23):1743–9.
18. Boivin-Proulx LA, Ieroncig F, Demers SP, Nozza A, Soltani M, Ghersi I, et al. Contemporary frequency and predictors of left ventricular thrombus in patients with anterior acute myocardial infarction. Clin Res Cardiol. 2023;112(4):558–67.
19. Vinik AI, Erbas T, Park TS, Nolan R, Pittenger GL. Platelet dysfunction in type 2 diabetes. Diabetes Care. 2001;24(8):1476–85.
20. Benowitz NL, Fitzgerald GA, Wilson M, Zhang Q. Nicotine effects on eicosanoid formation and hemostatic function: comparison of transdermal nicotine and cigarette smoking. J Am Coll Cardiol. 1993;22(4):1159–67.
21. Habash F, Vallurupalli S. Challenges in management of left ventricular thrombus. Ther Adv Cardiovasc Dis. 2017;11(8):203–13.
22. Meurin P, Brandao Carreira V, Dumaine R, Shqueir A, Millaire A, Tricot O, et al. Incidence, diagnostic methods, and evolution of left ventricular thrombus in patients with anterior myocardial infarction and low left ventricular ejection fraction: a prospective multicenter study. Am Heart J. 2015;170(2):256–62.
23. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233–70.
24. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–4.
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Copyright (c) 2025 Sultan Hikmat Yar, Junaid Bahadar, Sardar Zeeshan Akbar, Atta Ul Wadood, Shah Zeb, Umar Adil (Author)
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