E-wave propagation index predicts left ventricular thrombus in patients after ST-elevation myocardial infarction

Abstract Objective To investigate the association between the E-wave propagation index (EPI) and the presence of left ventricular (LV) thrombus as assessed by cardiac magnetic resonance imaging (MRI), the gold standard for LV thrombus detection. EPI could be a simple and effective echocardiographic parameter to identify patients at high risk of LV thrombus after ST-elevation myocardial infarction (STEMI). Materials and methods We included 665 STEMI patients treated with primary percutaneous coronary intervention enrolled in the Magnetic Resonance Imaging in acute STEMI (MARINA-STEMI) study. EPI was measured using transthoracic echocardiography at 3 (IQR 2–4) days after STEMI. LV thrombus was evaluated with cardiac MRI at 4 (IQR 3–5) days post-STEMI. Results A total of 665 STEMI patients (17% female) with a median age of 58 IQR 52-66 years were included. Patients with LV thrombus (n=32, 5%) had a significantly lower EPI than patients without LV thrombus (0.92 versus 1.29, p0.001). EPI significantly predicted the presence of LV thrombus (OR 0.08 95% confidence interval 0.03-0.26, p0.001), and this association remained significant after adjustment for clinical, angiographic and MRI predictors of LV thrombus. EPI of 0.95 emerged as best cut-off to identify patients at high risk of LV thrombus formation (15.9% thrombus rate in patients with EPI0.95 as compared to 2.5% in patients with EPI≥0.95). Conclusion In this MRI analysis, EPI emerged as significant and independent predictor of LV thrombus formation in STEMI patients. These findings highlight the usefulness of EPI as simple echocardiographic parameter to optimize LV thrombus screening in routine STEMI care.