| BackgroundLeft ventricular aneurysm(LVA)is one of the most severe mechanical complications after ST-elevation myocardial infarction(STEMI),and it occurs in<5%of patients[1,2].Patients with LVA frequently develop cardiac dysfunction,thromboembolism,ventricular arrhythmia.Ventricular aneurysm can be divided into true ventricular aneurysm and ventricular pseudoaneurysm.True ventricular aneurysm is prone to have left ventricular thrombus(LVT),whose incidence rate was 20%-30%[3],and the incidence of LVT was as high as 41.4%in the surgical ventricular aneurysm resection[4].In recent years,the reported incidence of LVA with LVT has decreased[5],primarily due to treatments of acute myocardial infarction with anticoagulant,antiplatelet and reperfusion therapy performed in the early stage of the event,as well as good management of heart failure and improvement of nursing mode.However,the fresh mural thrombus is easy to fall off,which may lead to embolism of vital organs and even sudden death,prolonged hospital stays,decreased quality of life,and bring heavy medical burden to families and society.It is one of the most serious complications of acute STEMI.Currently,the diagnosis of LVA complicated with LVT mostly need to rely on transthoracic echocardiography,which cannot effectively identify high-risk patients with LVA complicated with LVT in the early stage,leading to the occurrence of vital organ embolism in some patients when it is detected.This study retrospectively analyzed the related factors for LVT in patients with early stage of acute STEMI and LVA,and provided clinical evidence for the early detection,prevention,treatment of LVT.ObjectiveTo investigate the related factors of LVT formation within two weeks in patients with acute STEMI complicated with LVA.MethodA total of 144 inpatients were derived from a retrospective cohort who were with early stage of acute STEMI and left ventricular aneurysm hospitalized from January 2014 to June 2020 in the First Affiliated Hospital of Zhengzhou University.They were divided into non-LVT group(n=92)and LVT group(n=52)according to absence or presence of LVT.(1)Non-LVT group:echocardiography showed simple LVA.(2)LVT group:echocardiography showed LVA with LVT.Each patient’s gender,age,medical history,family history of coronary heart disease,smoking history,heavy drinking history were recorded and compared at baseline.The laboratory data,echocardiography findings,coronary angiography and treatments were compared between the two groups.Subgroup analysis was performed on the patients receiving percutaneous coronary intervention(PCI).Onset to door(OTD),door to balloon(DTB),onset to balloon(OTB)time were also compared.Multivariate logistic regression was used to analyze the related factors for LVT in early stage of acute STEMI complicated with LVA patients.The effects of every index in multivariate logistic regression analysis were illustrated in the forest plot.Result1.A total of 144 patients were enrolled,including 92 patients(63.9%)in the non-LVT group,52 patients(36.1%)in the LVT group.Patients in LVT group were younger compared with those in non-LVT group,and the former had a higher proportion of patients under 60 years old.Concentration of creatinine was higher in patients in LVT group and their history of chronic kidney disease,heavy drinking and anemia were more frequent,while they had lower concentration of hemoglobin and lower proportion of history of angina(P<0.05).2.Comparison of imaging data and treatment regiments:Compared with non-LVT group,patients in LVT group had lower LVEF and a higher proportion of patients with LVEF≤40%.The proportion of patients who had preoperative thrombosis in myocardial infarction(TIMI)blood flow grade 0,postoperative TIMI blood flow grade ≤2 were higher in LVT group(P<0.05).LVT group had a lower proportion of coronary collateral circulation and primary PCI or venous thrombolysis(P<0.05),while the differences in the use of antiplatelet therapy,preoperative low molecular weight heparin,and intraoperative anticoagulant drugs between the two groups were not statistically significant(P>0.05).3.Subgroup analysis of patients treated with primary PCI:144 patients,61(42.4%)received primary reperfusion therapy,of which 55 patients(38.2%,55/144)were treated with primary PCI,41 patients(44.6%,41/92)in non-LVT group were treated with primary PCI,14 patients(26.9%,14/52)in LVT group were treated with primary PCI,the difference was statistically significant(P<0.05).Subgroup analysis showed that the DTB time of non-LVT group was shorter than that of LVT group,but the difference was not statistically significant(P>0.05).There was no statistically significant difference in OTD and OTB time between the two groups(P>0.05).4.Multivariate logistic regression analysis and forest plot showed that history of heavy drinking(OR=6.982,95%CI 1.501-32.469,P=0.013),anemia(OR=3.373,95%CI 1.075-10.585,P=0.037),LVEF≤40%(OR=3.016,95%CI 1.027-8.859,P=0.045),preoperative TIMI blood flow grade 0(OR=3.311,95%CI 1.214-9.029,P=0.019)were positively correlated with LVT in patients with acute STEMI and LVA.History of angina(OR=0.159,95%CI 0.058-0.441,P<0.001),collateral circulation of the coronary arteries(OR=0.189,95%CI 0.053-0.673,P=0.010),primary PCI or venous thrombolysis(OR=0.252,95%CI 0.093-0.682,P=0.007)were negatively correlated with LVT in patients with acute STEMI and LVA.ConclusionHistory of heavy drinking,anemia,LVEF≤40%,preoperative TIMI blood flow grade 0 were associated with increased risk of the LVT in patients with acute STEMI and LVA at early stage of the disease.However,history of angina,collateral circulation of the coronary arteries,primary PCI or venous thrombolysis were associated with decreased risk of the LVT in these patients. |
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