European heart journal. Cardiovascular Imaging · 2026
Peak apical rotation independently predicts left ventricular thrombus following anterior myocardial infarction.
СтатьяНазвание и аннотация: Перевод в очереди
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Jones Johanna, Coldea Bianca, Butt Haroun, El-Rekaby Elly, Joshi Abhishek, Rathod Krishnaraj, Jones Richard, Keeble Thomas R, Lloyd Guy, Mathur Anthony, Jones Daniel
Аннотация
AIM: To evaluate the predictive and discriminatory value of peak apical rotation for LV thrombus formation following anterior MI.
METHODS AND RESULTS: In a multicentre prospective observational study, peak apical rotation was quantified post-hoc in 270 patients presenting with anterior MI using speckle tracking echocardiography. LV thrombus was identified by echocardiography or CMR during index admission or follow-up. Associations were evaluated using multivariable regression models and discrimination assessed using receiver-operating characteristic analysis.LV thrombus was identified in 33% of the eligible patients. Peak apical rotation was significantly lower in patients with thrombus (5.0° vs 9.8°, p < 0.001). After multivariate adjustment, higher apical rotation was independently protective against thrombus (OR 0.45, p < 0.001), corresponding to an approximately 2-fold increase in thrombus odds for every 1° reduction in rotation. Admission apical rotation also independently predicted delayed thrombus development (0.46, p < 0.001). Apical rotation demonstrated superior discrimination for thrombus compared to LVEF (AUC: 0.91 vs 0.62, p < 0.001), maintaining accuracy within the LVEF ≤40% subgroup (AUC: 0.89 vs 0.48, p < 0.001).
CONCLUSION: Impaired peak apical rotation independently predicts and discriminates LV thrombus following anterior MI, outperforming global systolic parameters. Prospective validation is required to establish apical rotation as a tool for risk stratification.
METHODS AND RESULTS: In a multicentre prospective observational study, peak apical rotation was quantified post-hoc in 270 patients presenting with anterior MI using speckle tracking echocardiography. LV thrombus was identified by echocardiography or CMR during index admission or follow-up. Associations were evaluated using multivariable regression models and discrimination assessed using receiver-operating characteristic analysis.LV thrombus was identified in 33% of the eligible patients. Peak apical rotation was significantly lower in patients with thrombus (5.0° vs 9.8°, p < 0.001). After multivariate adjustment, higher apical rotation was independently protective against thrombus (OR 0.45, p < 0.001), corresponding to an approximately 2-fold increase in thrombus odds for every 1° reduction in rotation. Admission apical rotation also independently predicted delayed thrombus development (0.46, p < 0.001). Apical rotation demonstrated superior discrimination for thrombus compared to LVEF (AUC: 0.91 vs 0.62, p < 0.001), maintaining accuracy within the LVEF ≤40% subgroup (AUC: 0.89 vs 0.48, p < 0.001).
CONCLUSION: Impaired peak apical rotation independently predicts and discriminates LV thrombus following anterior MI, outperforming global systolic parameters. Prospective validation is required to establish apical rotation as a tool for risk stratification.