Apical longitudinal strain can help predict the development of left ventricular thrombus after anterior myocardial infarction

Abstract Background: Left ventricular (LV) thrombus formation is a common complication of anterior myocardial infarction (ANT-MI). The aim of this study was to investigate the relationship between apical longitudinal strain (ALS) and LV apical thrombus after ANT-MI. Methods: The cross-sectional study included a total of 235 patients who were followed up after primary percutaneous coronary intervention performed for ANT-MI and had a reduced LV ejection fraction (LVEF) (≤40%). Of these patients, 24 were excluded from the study, and the remaining 211 patients were included in the analysis. Patients were divided into two groups based on the presence (n = 42) or absence (n = 169) of LV thrombus detected by echocardiography. ALS was measured using speckle-tracking echocardiography. Results: Thrombus was detected in 42 of 211 patients. There was no significant difference between the groups regarding age or gender. Apical strain (AS), global longitudinal strain (GLS), apical wall thickness (AWT), and EF were significantly lower in patients with LV apical thrombus when compared to those without LV apical thrombus (AS, –5.00 ± 2.30% vs. −8.54 ± 2.48%, p < 0.001; GLS, −10.6 ± 3.54% vs. −12.1 ± 2.84%, p = 0.013; AWT, 4.71 ± 1.11 vs. 6.33 ± 1.78 mm, p < 0.001; EF, 31.40 ± 4.10% vs. 37.75 ± 3.17%, p < 0.001). On univariate and multivariate analyses, aneurysm (AA), AS, and AWT were found to be independent predictors of LV apical thrombus (AA, odds ratio [OR] 4.649, p = 0.010; AS, OR 1.749, p < 0.001; AWT, OR 0.729, p = 0.042). Conclusion: ALS is highly sensitive and specific for predicting LV thrombus after ANT-MI. An early and accurate evaluation of LV thrombus may prevent embolic complications, particularly cerebrovascular events.

Rivaroxaban as an Antithrombotic Agent in a Patient With ST-Segment Elevation Myocardial Infarction and Left Ventricular Thrombus: A Case Report.

The incidence of left ventricular (LV) thrombi in the setting of an anterior myocardial infarction has declined significantly since the advent of primary percutaneous coronary intervention coupled with contemporary antithrombotic strategies in ST-segment elevation myocardial infarctions (STE-ACS). Despite oral anticoagulation with the currently accepted, standard-of-care vitamin K antagonist, warfarin, major bleeding complications still arise. Rivaroxaban is a novel, direct oral factor X anticoagulant that has several advantageous properties, which can attenuate bleeding risk. We present a case in which a patient successfully underwent a 3-month course of rivaroxaban in addition to his dual antiplatelet regimen of aspirin and ticagrelor for his STE-ACS and LV thrombus with resultant complete dissolution.

Pericarditis constrictiva: Causa de falla cardiaca en una paciente joven / Constrictive pericarditis: A cause of heart failure in a young patient

La pericarditis constrictiva es una causa de falla cardiaca derecha, que produce típicamente una alteración diastólica progresiva. Su corrección quirúrgica es posible con la pericardiectomía. La presentación en jóvenes y el compromiso importante de la función sistólica son escenarios infrecuentes. Se presenta el caso de una joven de 17 años con un cuadro de falla cardiaca congestiva. Los hallazgos de la ecocardiografía y resonancia cardiaca confirmaron el diagnóstico de pericarditis constrictiva. Se evidenció una disfunción sistólica con hipocinesia apical severa y con presencia de una masa a este nivel, compatible con trombo por la respuesta a anticoagulantes. La pericardiectomía se difirió por un alto riesgo operatorio y criterios de mal pronóstico por resonancia cardiaca. (AU)

Constrictive pericarditis is a cause of right heart failure that typically produces a progressive diastolic dysfunction. Pericardiectomy is the surgical indicated procedure. Presentation in young patients and systolic involvement are infrequent findings. We present the case of a 17-year-old female patient with congestive heart failure; findings of the heart ultrasound and magnetic resonance confirmed the diagnosis of constrictive pericarditis. Systolic dysfunction with severe apical hypokinesis and a mass like lesion compatible with a thrombus were observed. Pericardiectomy was deferred for the high surgical risk and for the bad prognostic findings on the magnetic resonance. (AU)

Rivaroxaban for treatment of intraventricular thrombus in Chagas disease.

Chagas disease leads to congestive heart failure, apical aneurysm, and may cause stroke or systemic embolism for intraventricular thrombus. We present a case of a 61-year-old man admitted for stroke 5 months after a renal embolism. An intraventricular thrombus was observed, probably the source of the cerebral and renal embolisms. The patient refused warfarin and rivaroxaban was used instead. After 40 days of treatment the thrombus had dissolved, after 20 months of regular use of rivaroxaban no more embolic events were observed. The use of rivaroxaban was effective in preventing embolic events in Chagas disease and intraventricular thrombus. .