{
  "abstract": "Background The reported incidence of left ventricular (LV) thrombus after ST elevation myocardial infarction (STEMI) varies significantly, with studies reporting incidence from 2% to as high as 20% depending on the patient cohort scanned, the timing of the scan and the modality used. Routine clinical practice in the United Kingdom remains an echocardiogram prior to discharge, usually 24–48 hours post infarct.Current data suggests that the highest risk cohort for LV thrombus formation are anterior STEMI patients, with apical akinesia or dyskinesia and LV ejection fraction (EF) <50%. The time point at which the highest incidence of thrombus formation will have occurred is similarly poorly defined, though 14 days post infarct has been proposed. What is known is that cardiac magnetic resonance (CMR) has a much higher sensitivity than non-contrast echocardiogram to detect LV thrombus. We sought to compare the incidence of LV thrombus formation in this high-risk group at 2- and 14-days post infarct using CMR.Methods We recruited 2 cohorts of patients after anterior STEMI with EF <50%, apical akinesia and no thrombus seen on initial post infarct echocardiogram – group 1 underwent CMR at day 2 and group 2 at day 14. All patients underwent CMR on a Phillips Ingenia 1.5T (Phillips, Netherlands) using standard protocols including volumes, early and late gadolinium enhanced imaging.Normally distributed continuous variables were compared with independent sample T test and presented as means with standard deviations. Proportions were compared with χ2 squared. P values of <0.05 were considered significant.Results In total 55 patients were recruited. 29 were scanned on day 2, 26 were scanned at day 14.All patients were prescribed aspirin and prasugrel, with none prescribed anticoagulation before CMR.Overall, 12 (46%) of patients scanned at Day 14 had LV thrombus compared to 4 (14%) scanned at day 2 (p 0.009).Results comparing the two groups are shown in table 1.Abstract 6-001 Table 1A comparison of those scanned at day 14 with thrombus and those without is shown in table 2.Abstract 6-001 Table 2Conclusion In this anterior STEMI cohort, we have shown a significantly higher incidence of LV thrombus when scanning with CMR at day 14 than scanning at day 2, with a notably high incidence at day 14 compared to previous studies. Conventional risk factors do not seem to influence LV thrombus incidence, however residual apical akinesia at 2 weeks was significantly more prevalent in those who went on to have thrombus.It is likely that the current routine practice of non-contrast echocardiography before discharge may under diagnose LV thrombus in this cohort, how this corresponds to outcomes remains unclear. Larger studies, ideally with repeat scans in the same patients, is required to confirm the ideal timing of CMR.Abstract 6-001 Figure 1Early gadolinium enhanced 4 chamber showing extensive microvascular obstruction and large apical LV thrombusAbstract 6-001 Figure 2Late gadolinium enhanced ventricular long axis showing extensive infarction and large apical LV thrombus",
  "authors": [
    {
      "affiliations": [
        "University of Leeds, Leeds, UK"
      ],
      "name": "Thomas Anderton"
    },
    {
      "affiliations": [
        "University of Leeds, Leeds, UK"
      ],
      "name": "Lisa Borg"
    },
    {
      "affiliations": [
        "University of Leeds, Leeds, UK"
      ],
      "name": "Raluca Tomoaia"
    },
    {
      "affiliations": [
        "University of Leeds, Leeds, UK"
      ],
      "name": "Bradley Chambers"
    },
    {
      "affiliations": [
        "University of Leeds, Leeds, UK"
      ],
      "name": "Maryam Farooq"
    },
    {
      "affiliations": [
        "University of Leeds, Leeds, UK"
      ],
      "name": "Chin Yit Soo"
    },
    {
      "affiliations": [
        "University of Leeds, Leeds, UK"
      ],
      "name": "May Lwin"
    },
    {
      "affiliations": [
        "University of Leeds, Leeds, UK"
      ],
      "name": "Mehak Asad"
    },
    {
      "affiliations": [
        "University of Leeds, Leeds, UK"
      ],
      "name": "Peter Swoboda"
    },
    {
      "affiliations": [
        "University of Leeds, Leeds, UK"
      ],
      "name": "Heerajnarain Bulluck"
    },
    {
      "affiliations": [
        "Newcastle University, Newcastle upon Tyne, UK"
      ],
      "name": "Ioakim Spyridopoulos"
    },
    {
      "affiliations": [
        "University of Leeds, Leeds, UK"
      ],
      "name": "Sven Plein"
    }
  ],
  "title": "6-001 Left ventricular thrombus incidence assessed by cardiac magnetic resonance at day 2 and 14 after ST elevation myocardial infarction",
  "uid": "d7d24420-304a-503d-8bcc-9bc45f9d688f"
}