Clinical Characteristics And Independent Risk Factors Of Left Ventricular Thrombus In Patients With Acute ST-segment Elevation Myocardial Infarction

Object:By analyzing the baseline data,biochemical examination,color Doppler echocardiography results and clinical features of patients with acute ST segment elevation myocardial infarction(STEMI)complicated with left ventricular thrombus(LVT),we investigate the independent risk factors of STEMI combined with LVT,and provide a theoretical reference for the prevention and early detection of LVT in patients with STEMI.Methods:From January 1,2014 to June 30,2017,seventy-four patients diagnosed as STEMI with LVT in the Department of Cardiology,the first Bethune Hospital of Jilin University,were analyzed retrospectively.The patients were defined as LVT group.One hundred and forty-eight patients who were diagnosed as STEMI and not complicated with LVT at the same time were randomly selected and defined as non-LVT group.The clinical data of all patients were collected,and a database was established to analyze and compare the clinical baseline data,the biochemical examination after admission,the results of color Doppler echocardiography,and the clinical features of the two groups.The independent risk factors of STEMI combined with LVT were analyzed by binary Logistic regression analysis.Results:(1)The median duration before admission in LVT group was 53 hours,while that in non-LVT group was 8 hours,the difference was statistically significant(p <0.01).The median length of hospitalization in LVT group was 7 days,while that in non-LVT group was 6 days,the difference was statistically significant(p < 0.05).Thepercentage of male patients in LVT group(82.4%)was higher than that in non-LVT group(73.0%),but there was no significant difference between the two groups(p >0.05).There was no significant difference in age,smoking and basic diseases(hypertension,diabetes,hyperlipidemia,cerebral infarction)between the two groups(p > 0.05).(2)The peak value of troponin,N-terminal pro-B type natriuretic peptide(NT-pro BNP),D-dimer,prothrombin time,international standardized ratio,fibrinogen,mean platelet volume(MPV)and serum creatinine in LVT group were significantly higher than those in non-LVT group,the difference was statistically significant(p < 0.01).High density lipoprotein cholesterol(HDL-C)in LVT group was significantly lower than that in non-LVT group(p < 0.05).There was no significant difference in the creatine kinase,white blood cell,hemoglobin,platelet,triglyceride,low density lipoprotein cholesterol(LDL-C),and serum uric acid between the two groups(p > 0.05).(3)Compared with the two groups,the median left ventricular end-diastolic diameter(55mm)in LVT group was larger than that in non-LVT group(50mm),and the median LVEF value(41%)was lower than that in non-LVT group(53%),there was significant difference between the two groups(p < 0.01).Compared with the non-LVT group,the number of LVEF ? 40%,left ventricular wall pulsatile diffuse weakening,moderate to severe mitral regurgitation,pericardial effusion in LVT group were significantly higher,the difference was statistically significant(p < 0.01).(4)Compared with the clinical features of the two groups,the percentage of anterior wall myocardial infarction in LVT group was 95.9% and 33.8% with Killip grade ? II grade,while that in non-LVT group was 32.4% and 16.9%,respectively,there was significant difference between the two groups(p < 0.01).In terms of treatment regimen,the percentage of LVT patients undergoing PCI and drug conservative therapy was 44.6%,55.4% respectively,and that of non-LVT group was57.4%,42.6% respectively,there was no significant difference between the two groups(p > 0.05).(5)Binary Logistic regression analysis showed that acute anterior wallmyocardial infarction,long course of disease before admission,decrease of LVEF,high peak value of troponin,large MPV are independent risk factors for LVT in STEMI patients.Anterior wall myocardial infarction,the prolongation of the course of disease before admission,the decrease of LVEF and the increase of cardiac troponin peak value and MPV increased the risk of LVT formation in STEMI patients.(6)In comparison between emergency PCI(< 12 h)and delayed PCI(? 12 h)in PCI group,33 patients were treated with PCI in LVT group.Among them,the number of emergency PCI and delayed PCI were 13(39.4%)and 20(60.6%),respectively.In non-LVT group,85 patients were treated with PCI,of which 71(83.5%)were treated with emergency PCI.There was significant difference between the two groups(p <0.01).(7)The results of ROC curve analysis showed that the area under the ROC curve of cardiac troponin peak and MPV were 0.638 and 0.763,respectively,and the P values were 0.001,0.000 respectively.There was statistical difference between them,which had certain diagnostic value for STEMI combined with LVT.When the peak value of troponin > 3.1 ng / ml and the MPV > 10.5fL,the patients with STEMI were more likely to develop LVT.Conclusion:The formation of LVT in patients with STEMI is affected by many factors.Long course of disease before admission,acute anterior wall myocardial infarction,increased peak troponin,decreased LVEF,increased MPV are independent risk factors for LVT in STEMI patients.When the peak value of troponin > 3.1 ng /ml and MPV >10.5 fL,it may be useful for the diagnosis of the formation of LVT in patients with STEMI.