Study on risk factors for left ventricular thrombosis after first acute anterior wall myocardial infarction

Objective: Left ventricular thrombosis is one of the complications of acute myocardial infarction, and the high-risk factors in first acute anterior myocardial infarction have not been fully elucidated. This study aimed to explore the risk factors for left ventricular thrombosis in patients with their first acute anterior myocardial infarction. Methods: We retrospectively analyzed the clinical data of 84 patients diagnosed with their first acute anterior myocardial infarction in the Department of Cardiovascular Medicine, Gulou Clinical College, Xuzhou Medical University, from March 2019 to June 2023 and divided them into a thrombosis group (left ventricular thrombosis, n = 35) and a control group (no left ventricular thrombosis, n = 49) according to the presence or absence of left ventricular thrombosis. The baseline data and imaging characteristics of the two groups of patients were retrospectively analyzed. Univariate and multivariate logistic regression analysis was used to evaluate the risk factors for left ventricular thrombosis. Results: In univariate analysis, female sex, diabetes, hypercholesterolemia, ALT, AST, CRP, NT-ProBNP, D-dimer, CKMB peak, cTnI, LVEF, and WMS (wall motion score 1–5) were significantly associated with left ventricular thrombosis (P < 0.05). Multivariate analysis showed that female sex, diabetes, hypercholesterolemia, ALT, AST, CRP, NT-ProBNP, D-dimer and WMS (wall motion score 1–5) were independent risk factors for left ventricular thrombosis (P < 0.05). Based on the analysis of hemodynamic characteristics, left ventricular segmental systolic dysfunction after anterior wall myocardial infarction leads to changes in the velocity gradient of intraventricular blood flow, local blood flow stasis, and abnormal shear stress. This is especially true in patients with significantly reduced LVEF (< 40%) and wall motion scores ≥ 3. The vortexes formed by changes in ventricular geometry, together with endothelial injury, jointly constitute the physical basis for thrombosis formation. Conclusion: This study found that gender, diabetes, hypercholesterolemia/lipidemia, inflammatory markers (such as CRP), myocardial injury markers (such as NT-ProBNP, CKMB, cTnI), thrombosis markers (such as D-dimer), and left ventricular dysfunction were closely associated with left ventricular thrombosis after the first acute anterior wall myocardial infarction. These results help to better understand the pathogenesis of left ventricular thrombosis after myocardial infarction and provide important clues for early prevention and intervention.