Abstract

Background

Left ventricular apical thrombus (LVAT) formation is a well-known complication of acute anterior myocardial infarction (AMI). The CHA2DS2VASc is a scoring system that has been used to estimate the risk of thromboembolism in patients with nonvalvular atrial fibrillation. This score has also been used for other clinical conditions. The aim of this study was to investigate the relationship between CHA2DS2VASc score and development of LVAT in patients with AMI.

Method

The study population included 378 patients (mean age: 56.5 ± 12.3 years, male: 318) presenting with AMI between January 2016 and January 2020. Primary percutaneous coronary intervention procedure was performed in all patients. Initial echocardiogram was performed within 7 days of admission. All patients were evaluated with echocardiography at 3rd, 6th and 12th months. Patients were divided into two groups according to the presence of LVAT on echocardiography.

Results

The incidence of the LVAT was 8.5% (n = 32) during a mean follow-up time of 233.1 ± 66.7 days. The mean CHA2DS2VASc score was notably higher in patients with LVAT compared to patients in the control group (3.1 ± 1.9 vs. 1.9 ± 1.2, p < 0.001). In Cox regression analysis, high CHA2DS2VASc score, low left ventricular ejection fraction (LVEF) and the presence of LV apical akinesis/aneurysm were the independent predictors for LVAT formation. All of these parameters were associated with higher cumulative incidence of LVAT formation in Kaplan-Meier analyses (p < 0.001 for all).

Conclusion

High CHA2DS2VASc score, low LVEF and the presence of LV apical akinesis/aneurysm may be used for LVAT risk prediction among patients presenting with AMI.

中文翻译：

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急性前ST段抬高型心肌梗死患者CHA2DS2VASc评分与左心室心尖部血栓形成的关系

摘要

背景

左心室心尖血栓( LVAT) 形成是急性前壁心肌梗死 (AMI) 的一种众所周知的并发症。CHA2DS2VASc 是一种评分系统，已用于评估非瓣膜性心房颤动患者的血栓栓塞风险。该分数也已用于其他临床情况。本研究的目的是探讨 AMI 患者 CHA2DS2VASc 评分与 LVAT 发展之间的关系。

方法

研究人群包括在 2016 年 1 月至 2020 年 1 月期间出现 AMI 的 378 名患者（平均年龄：56.5 ± 12.3 岁，男性：318 名）。所有患者均接受了直接经皮冠状动脉介入治疗。首次超声心动图在入院后 7 天内进行。所有患者均在第 3、6 和 12 个月时接受超声心动图评估。根据超声心动图中是否存在 LVAT，将患者分为两组。

结果

 在 233.1 ± 66.7 天的平均随访时间内，LVAT 的发生率为 8.5%（n = 32）。与对照组患者相比，LVAT 患者的平均 CHA2DS2VASc 评分明显更高（3.1 ± 1.9 对 1.9 ± 1.2，p  < 0.001）。在 Cox 回归分析中，高 CHA2DS2VASc 评分、低左心室射血分数 (LVEF) 和 LV 心尖运动不能/动脉瘤的存在是 LVAT 形成的独立预测因子。在 Kaplan-Meier 分析中，所有这些参数都与 LVAT 形成的较高累积发生率相关（ 所有p < 0.001）。

结论

高 CHA2DS2VASc 评分、低 LVEF 和 LV 心尖运动不能/动脉瘤的存在可用于预测 AMI 患者的 LVAT 风险。