This research determines that left ventricular thrombus can be predicted in the first 6 months after infarction from easily accessible variables before hospital discharge.
The study proposes an action scheme to efficiently allocate resources to patients at higher risk of suffering this complication.
A study led by the INCLIVA Health Research Institute, the Hospital Clínico Universitario de València and the Cardiovascular Diseases area of the Centro de Investigación Biomédica en Red (CIBERCV), has developed an innovative model to predict left ventricular thrombus after acute myocardial infarction.
The study was conducted in collaboration with the Complejo Asistencial Universitario de Salamanca (CAUSA), the Instituto de Investigación Biomédica de Salamanca (IBSAL), the Hospital Clínico Universitario de Salamanca and the Hospitales Clínic and Universitario Vall d’Hebron de Barcelona,
Left ventricular thrombus is a serious and potentially lethal complication that can appear after acute myocardial infarction. Its precise detection is complex and it has not yet been defined which patients should be screened and followed up more closely. This study proposes a scheme of action that would allow efficient allocation of resources to the patients at greatest risk.
The study, led by Dr. Víctor Marcos Garcés, researcher of the Translational Research Group on Ischemic Heart Disease of INCLIVA and CIBERCV, and cardiologist of the Cardiology Department of the Hospital Clínico Universitario de València, concludes that left ventricular thrombus can be predicted in the first 6 months after infarction based on variables that are easily accessible before hospital discharge. According to the results, 20% of patients would develop left ventricular thrombus in the highest risk group.
A serious complication
“Left ventricular thrombus is a serious complication that significantly increases the risk of stroke and mortality, even years after myocardial infarction. Although cardiac ultrasound is a commonly used tool, it has limitations, since up to half of the thrombi can go undetected with this technique,” explained Dr. Carlos Bertolín Boronat, cardiologist and lead author of the study. “Cardiac magnetic resonance imaging, on the other hand, offers greater precision, but its high cost and limited availability make its widespread implementation difficult,” he added.
The study, carried out at the Hospital Clínico Universitario de València, provides a promising solution to optimize the detection of these thrombi and move towards precision medicine. In the study, 590 patients with acute myocardial infarction were evaluated during hospital admission by means of clinical history, electrocardiograms and cardiac ultrasound. Subsequently, they underwent cardiac magnetic resonance imaging to comprehensively analyze the structure and function of the heart and detect the ventricular thrombus more reliably.
“The study findings are encouraging: through routine assessments during hospital admission, it is possible to assign an individualized risk of developing left ventricular thrombus in the first six months after infarction,” said Dr. Víctor Marcos Garcés, a CIBERCV research cardiologist who works in the Post-Infarction Cardiac Rehabilitation Unit of the Hospital Clínico Universitario de València and is part of the team that performs cardiac MRI at the center, with the collaboration of the Radiodiagnostic Service.
“This approach would allow more cases to be identified earlier, reducing associated complications and optimizing available resources. In particular, we propose to prioritize MRI in those patients at highest risk, achieving a balance between diagnostic efficacy and economic sustainability,” he concluded.
The conclusions of the study, which have been presented at multiple national and international congresses, open up a new perspective in the management of post-infarction complications, highlighting the importance of personalizing diagnostic resources according to the individual risk of each patient.
Carlos Bertolín Boronat and Vicente Bodí from INCLIVA, Hospital Clínico Universitario de València and Universitat de València (UV) also participated in the study. Also taking part were doctors Pedro L. Sánchez, Candelas Pérez del Villar and Cristian Herrera, from the Cardiology Department of the Complejo Asistencial Universitario de Salamanca and researchers from the Instituto de Investigación Biomédica de Salamanca; Blanca Domenech-Ximenos and José T. Ortiz-Pérez, from the Hospital Clínic de Barcelona; and José Fernando Rodríguez-Palomares, head of the Cardiovascular Imaging Unit of the Hospital Universitario Vall d’Hebron de Barcelona. The four institutions belong to the Centro de Investigación Biomédica en Red (CIBER) consortium.The results of this research, which has received support through a GE 2023 grant from the Conselleria de Educación, Cultura, Universidades y Ocupación de la Generalitat Valenciana (CIGE/2022/26) and the Instituto de Salud Carlos III (CIBERCV16/11/00486), have been published in the prestigious European Journal of Internal Medicine, entitled ‘Prediction of Left Ventricular Thrombus After Myocardial infarction: A Cardiac Magnetic Resonance-based Prospective Registry`.
Article reference:
Bertolin-Boronat, C., Marcos-Garcés, V., Merenciano-González, H., Perez, N., Pérez Del Villar, C., Gavara, J., Lopez-Lereu, M. P., Monmeneu, J. V., Herrera Flores, C., Domenech-Ximenos, B., López-Fornás, F. J., Rios-Navarro, C., de Dios, E., Moratal, D., Ortiz-Pérez, J. T., Bayes-Genis, A., Rodríguez-Palomares, J. F., Nuñez, J., Sánchez, P. L., Sanchis, J., … Bodi, V. (2024). Prediction of left ventricular thrombus after myocardial infarction: a cardiac magnetic resonance-based prospective registry. European journal of internal medicine, S0953-6205(24)00406-0. Advance online publication. https://doi.org/10.1016/j.ejim.2024.09.015
Link to publication: https://www.ejinme.com/article/S0953-6205(24)00406-0/fulltext
