Association between the E-wave propagation index and left ventricular thrombus formation after ST-elevation myocardial infarction. (1st March 2021)

• Record Type: Journal Article
• Authors: Duus, Lisa Steen; Pedersen, Sune; Ravnkilde, Kirstine; Galatius, Søren; Fritz-Hansen, Thomas; Biering-Sørensen, Tor; Olsen, Flemming Javier
• Is Part Of: International journal of cardiology. Volume 326(2021)
• Page Start: 213
• Page End: 219
• Publication Date: 2021-03-01
• Subjects: Left ventricular thrombus -- ST-elevation myocardial infarction -- Echocardiography -- E-wave propagation index; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2020.10.078
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Objective: To explore the association between E -wave propagation index (EPI) as a marker of apical washout and the risk of left ventricular thrombus (LVT) formation in patients with ST-elevation myocardial infarction (STEMI). Methods: We performed a post-hoc analysis on 364 prospectively enrolled STEMI patients from a single-center. Non-contrast transthoracic echocardiographic examinations were performed a median of 2 days (IQR:1–3 days) after PCI. The endpoint was LVT formation, identified retrospectively. Univariable and multivariable logistic regression was applied to assess the association between EPI and LVT formation. Multivariable adjustments included LVEF, LAD culprit, prior myocardial infarction, heart rate, and early myocardial relaxation velocity. Area under receiver operating characteristic curves (AUC) was used to assess the diagnostic ability. Results and conclusions: Among 364 patients, 31 (8.5%) developed LVT. The mean age was 62 years, 75% were men, and mean LVEF was 46%. Patients developing LVT had increased heart rate, lower LVEF, impaired GLS, and more frequently had prior myocardial infarction. Variables associated with low values of EPI included, among others, LVEF, LV aneurysm, and GLS. EPI and LVT formation were significantly associated in the univariable model (OR = 1.87 (1.53–2.28), p < 0.001 ), and EPI showed an AUC of 0.90. After multivariable adjustments, EPI and LVT formation remained significantly associated (OR = 1.79 (1.42–2.27), p < 0.001 ). Patients with an EPI < 1.0 had a 23 times higher likelihood of LVT formation (OR = 23.41 (10.06–54.49), p < 0.001 ). EPI and LVT formation are strongly associated in patients with STEMI, with low values of EPI indicating a markedly increased probability of LVT formation. Highlights: E-wave propagation index (EPI) is an echocardiographic marker of apical blood flow. An EPI < 1 indicates an elevated likelihood of mural thrombus development after STEMI. An EPI cutoff of 1 may be used as an adjunct to rule out presence of mural thrombus.