Chest
Clinical InvestigationsPrevalence of Mural Thrombi and Systemic Embolization with Left Ventricular Aneurysm: Effect of Anticoagulation Therapy
Section snippets
Patient Population
The study population consisted of 58 consecutive patients from September 1971 through December 1976 at the University of Alabama Medical Center undergoing (1) coronary angiography, (2) biplane LV angiography, and (3) resection of postinfarction LV aneurysm. Patients having cardiac catheterization at other hospitals and referred to this institution for surgery were not included in this analysis. Due to the referral nature of this institution, uniformity in clinical management prior to surgery
Clinical and Angiographic Data
Fifty eight patients satisfied the study criteria (Table 1). The group was composed of 50 men and 8 women with an average age of 55 ± 1 years. The mean elapsed time since MI was 26 ± 6 months. Twenty-eight patients, representing 48 percent, had multivessel coronary artery disease representing either two or three-vessel disease. The mean LV end-diastolic pressure was 17 ± 1 mm Hg, while the average ejection fraction was 23 ± 1 percent. The mean size of the abnormally contracting segment was 32
Discussion
The results of this study suggest the following: (1) the prevalence of mural thrombi is high in patients with LV aneurysm; (2) factors such as severity of coronary artery disease, LV function, and size of the abnormally contracting segment do not identify patients at risk to have mural thrombi; (3) biplane LV angiography is neither sensitive nor specific for the detection of mural thrombi; (4) clinically apparent systemic embolization is uncommon and does not appear to be affected by long-term
Acknowledgments
The authors gratefully acknowledge the secretarial assistance of Ms. Dana Murray. Gratitude is expressed to cardiovascular surgeons John W. Kirklin, M.D., Robert B. Karp, M.D., and Albert D. Pacifico, M.D., for the opportunity to include their patients in this study.
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2008, Journal of the American College of CardiologyCitation Excerpt :Infarct location and severity of systolic dysfunction determine the propensity for thromboembolism (53). Dyskinetic segments that remodel into aneurysms remain chronic foci for potential thrombosis (54,55). Dilated cardiomyopathy is also associated with LV thrombus.
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2001, ChestCitation Excerpt :Theindication is strengthened in the presence of atrial fibrillation, CHF, dilated LV, acute ventricular aneurysm, or mural thrombus detected on2D echocardiography. Thrombus is commonly associated with a chronic LV aneurysm(association, 48 to 66% in surgical studies).28, 29 However, systemic emboli are infrequent (4 to 5% by preoperativehistory).
This research was supported by the National Heart and Lung Institute (Specialized Center of Research for Ischemic Heart Disease) Contract Number 1P17HL17667-04 by Program Project grant HL 11, 310, and by the Clinical Research Unit grant MO-RR000-13 (General Clinical Research Centers Program, Division of Research Resources of the National Institutes of Health).
Presented in part at the 27th Annual Scientific Session, American College of Cardiology, Anaheim, CA, March 6-9, 1978.
Manuscript received January 26; revision accepted June 21.