Left ventricular thrombus after acute myocardial infarction – case report and literature review
More details
Hide details
Students’ Scientific Club, 1st Department of Cardiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
1st Department of Cardiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
Corresponding author
Michał Razik   

Studenckie Koło Naukowe, I Katedra i Klinika Kardiologii, Wydział Nauk Medycznych w Katowicach, Śląski Uniwersytet Medyczny w Katowicach, ul. Ziołowa 47, 40-635 Katowice, Polska
Ann. Acad. Med. Siles. 2024;78:11-16
Left ventricular (LV) thrombus is a complication of acute myocardial infarction (AMI), especially in patients with anterior AMI and persistent LV systolic dysfunction. Regardless of the progress in invasive AMI therapy, there are literature data showing the frequency of LV thrombi ranging from 2.7% to 19.2% in patients with anterior ST elevation myocardial infarction (STEMI). LV thrombi formation is associated with endothelial injury, blood stasis, and hypercoagulability. Early diagnosis using transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) imaging is crucial. Prevention strategies involve assessing the risk factors and considering anticoagulant therapy in exceptional cases. Treatment involves anticoagulation for up to 6 months in combination with antiplatelet therapy. The study presents the current state of knowledge on LV thrombi, provided with a relevant case report as a practical guideline.
Honan K.A, Jogimahanti A., Khair T. An updated review of the efficacy and safety of direct oral anticoagulants in treatment of left ventricular thrombus. Am. J. Med. 2022; 135(1): 17–23, doi: 10.1016/j.amjmed.2021.07.023.
Robinson A.A., Jain A., Gentry M., McNamara R.L. Left ventricular thrombi after STEMI in the primary PCI era: A systematic review and meta-analysis. Int. J. Cardiol. 2016; 221: 554–559, doi: 10.1016/j.ijcard.2016.07.069.
Bulluck H., Chan M.H.H., Paradies V., Yellon R.L., Ho H.H., Chan M.Y. et al. Incidence and predictors of left ventricular thrombus by cardiovascular magnetic resonance in acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: a meta-analysis. J. Cardiovasc. Magn. Reson. 2018; 20(1): 72, doi: 10.1186/s12968-018-0494-3.
Velangi P.S., Choo C., Chen K.A., Kazmirczak F., Nijjar P.S., Farzaneh-Far A. et al. Long-term embolic outcomes after detection of left ventricular thrombus by late gadolinium enhancement cardiovascular magnetic resonance imaging: A matched cohort study. Circ. Cardiovasc. Imaging 2019; 12(11): e009723, doi: 10.1161/CIRCIMAGING.119.009723.
Camaj A., Fuster V., Giustino G., Bienstock S.W., Sternheim D., Mehran R. et al. Left ventricular thrombus following acute myocardial infarction: JACC State-of-the-Art Review. J. Am. Coll. Cardiol. 2022; 79(10): 1010–1022, doi: 10.1016/j.jacc.2022.01.011.
Delewi R., Zijlstra F., Piek J.J. Left ventricular thrombus formation after acute myocardial infarction. Heart 2012; 98(23): 1743–1749, doi: 10.1136/heartjnl-2012-301962.
Nihoyannopoulos P., Smith G.C., Maseri A., Foale R.A. The natural history of left ventricular thrombus in myocardial infarction: a rationale in support of masterly inactivity. J. Am. Coll. Cardiol. 1989; 14(4): 903–911, doi: 10.1016/0735-1097(89)90463-4.
Delewi R., Nijveldt R., Hirsch A., Marcu C.B., Robbers L., Hassell M.E. et al. Left ventricular thrombus formation after acute myocardial infarction as assessed by cardiovascular magnetic resonance imaging. Eur. J. Radiol. 2012; 81(12): 3900–3904, doi: 10.1016/j.ejrad.2012.06.029.
Weinsaft J.W., Kim J., Medicherla C.B., Ma C.L., Codella N.C., Kukar N. et al. Echocardiographic algorithm for post-myocardial infarction LV thrombus: A gatekeeper for thrombus evaluation by delayed enhancement CMR. JACC Cardiovasc. Imaging 2016; 9(5): 505–515, doi: 10.1016/j.jcmg.2015.06.017.
Asinger R.W., Mikell F.L., Elsperger J., Hodges M. Incidence of left-ventricular thrombosis after acute transmural myocardial infarction. Serial evaluation by two-dimensional echocardiography. N. Engl. J. Med. 1981; 305(6): 297–302, doi: 10.1056/NEJM198108063050601.
Byrne R.A., Rossello X., Coughlan J.J., Barbato E., Berry C., Chieffo A. et al. 2023 ESC Guidelines for the management of acute coronary syndromes: Developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC). Eur. Heart J. 2023; 44(38): 3720–3826, doi: 10.1093/eurheartj/ehad191.
O’Gara P.T., Kushner F.G., Ascheim D.D., Casey D.E. Jr., Chung M.K., de Lemos J.A. et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 127(4): e362–e425, doi: 10.1161/CIR.0b013e3182742cf6.
Srichai M.B., Junor C., Rodriguez L.L., Stillman A.E., Grimm R.A., Lieber M.L. et al. Clinical, imaging, and pathological characteristics of left ventricular thrombus: a comparison of contrast-enhanced magnetic resonance imaging, transthoracic echocardiography, and transesophageal echocardiography with surgical or pathological validation. Am. Heart J. 2006; 152(1): 75–84, doi: 10.1016/j.ahj.2005.08.021.
Weinsaft J.W., Kim H.W., Shah D.J., Klem I., Crowley A.L., Brosnan R. et al. Detection of left ventricular thrombus by delayed-enhancement cardiovascular magnetic resonance prevalence and markers in patients with systolic dysfunction. J. Am. Coll. Cardiol. 2008; 52(2): 148–157, doi: 10.1016/j.jacc.2008.03.041.
Martinez M.W., Kirsch J., Williamson E.E., Syed I.S., Feng D., Ommen S. et al. Utility of nongated multidetector computed tomography for detection of left atrial thrombus in patients undergoing catheter ablation of atrial fibrillation. JACC Cardiovasc. Imaging 2009; 2(1): 69–76, doi: 10.1016/j.jcmg.2008.09.011.
Chae S.Y., Kwon T.W., Jin S., Kwon S.U., Sung C., Oh S.J. et al. A phase 1, first-in-human study of 18F-GP1 positron emission tomography for imaging acute arterial thrombosis. EJNMMI Res. 2019; 9(1): 3, doi: 10.1186/s13550-018-0471-8.
Levine G.N., McEvoy J.W., Fang J.C., Ibeh C., McCarthy C.P., Misra A. et al. Management of patients at risk for and with left ventricular thrombus: A Scientific Statement from the American Heart Association. Circulation 2022; 146(15): e205–e223, doi: 10.1161/CIR.0000000000001092.
Massussi M., Scotti A., Lip G.Y.H., Proietti R. Left ventricular thrombosis: new perspectives on an old problem. Eur. Heart J. Cardiovasc. Pharmacother. 2021; 7(2): 158–167, doi: 10.1093/ehjcvp/pvaa066.
Lee J.M., Park J.J., Jung H.W., Cho Y.S., Oh I.Y., Yoon C.H. et al. Left ventricular thrombus and subsequent thromboembolism, comparison of anticoagulation, surgical removal, and antiplatelet agents. J. Atheroscler. Thromb. 2013; 20(1): 73–93, doi: 10.5551/jat.13540.
Journals System - logo
Scroll to top