急性心肌梗死左心室附壁血栓的临床特征及治疗进展
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摘要
左心室附壁血栓是急性心肌梗死的严重并发症,最常见于前壁ST段抬高型心肌梗死。经胸腔超声心动图是目前诊断左心室附壁血栓最常用的方法,心脏磁共振成像是最为敏感和特异的手段。左心室附壁血栓发生机制还未完全阐明,可能与Virchow’s三联征有关。左心室附壁血栓的预防和治疗还缺乏充分的证据,抗凝治疗的效果也不肯定,因而是临床研究亟待回答的问题。
Left ventricular thrombus(LVT) is a serious complication following acute myocardial infarction and is a potential cause of thromboembolic complications such as stroke. The incidence of LVT is still controversial due to different examination methods and loss of follow-up. The pathogenesis of LVT is still unknown,which may be related to the Virchow's triad. The prevention and treatment of LVT are still conundrum and the best anticoagulation strategies should be answered in future.
Left ventricular thrombus(LVT) is a serious complication following acute myocardial infarction and is a potential cause of thromboembolic complications such as stroke. The incidence of LVT is still controversial due to different examination methods and loss of follow-up. The pathogenesis of LVT is still unknown,which may be related to the Virchow's triad. The prevention and treatment of LVT are still conundrum and the best anticoagulation strategies should be answered in future.
引文
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[4] Cannon CP,Bhatt DL,Oldgren J,et al. Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation[J]. N Engl J Med,2017,377(16):1513-1524.
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[14] Weinreich DJ,Burke JF,Pauletto FJ. Left ventricular mural thrombi complicating acute myocardial infarction. Long-term follow-up with serial echocardiography[J]. Ann Intern Med,1984,100(6):789-794.
[15] Okuyan E,Okcun B,Dinckal MH,et al. Risk factors for development of left ventricular thrombus after first acute anterior myocardial infarction-association with anticardiolipin antibodies[J]. Thromb J,2010,8:15.
[16] Takasugi J,Yamagami H,Noguchi T,et al. Detection of left ventricular thrombus by cardiac magnetic resonance in embolic stroke of undetermined source[J].Stroke,2017,48(9):2434-2440.
[17] Acar Z,Ziyrek M,Korkmaz L,et al. Mean platelet volume at admission is a determinant of left ventricular thrombus formation after primary percutaneous coronary intervention for first anterior wall myocardial infarction[J]. Acta Cardiol,2014,69(6):603-609.
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[25] Ibanez B,James S,Agewall S,et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation:The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology(ESC)[J]. Eur Heart J,2018,39(2):119-177.
[26] le May MR,Acharya S,Wells GA,et al. Prophylactic warfarin therapy after primary percutaneous coronary intervention for anterior ST-segment elevation myocardial infarction[J]. JACC Cardiovasc Interv,2015,8(1 Pt B):155-162.
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[29] Rosendaal FR,Cannegieter SC,van der Meer FJ,et al. A method to determine the optimal intensity of oral anticoagulant therapy[J]. Thromb Haemost,1993,69(3):236-239.
[30] JCS Joint Working Group. Guidelines for Pharmacotherapy of Atrial Fibrillation(JCS 2013)[J]. Circ J,2014,78(8):1997-2021.
[31] Bjorck F,Renlund H,Lip GY,et al. Outcomes in a warfarin-treated population with atrial fibrillation[J]. JAMA Cardiol,2016,1(2):172-180.
[32] Nili M,Deviri E,Jortner R,et al. Surgical removal of a mobile,pedunculated left ventricular thrombus:report of 4 cases[J]. Ann Thorac Surg,1988,46(4):396-400.
[33] Mega JL,Braunwald E,Murphy SA,et al. Rivaroxaban in patients stabilized after a ST-segment elevation myocardial infarction:results from the ATLAS ACS-2-TIMI-51 trial(Anti-Xa Therapy to Lower Cardiovascular Events in Addition to Standard Therapy in Subjects with Acute Coronary Syndrome-Thrombolysis In Myocardial Infarction-51)[J]. J Am Coll Cardiol,2013,61(18):1853-1859.
[34] Connolly SJ,Eikelboom JW,Bosch J,et al. Rivaroxaban with or without aspirin in patients with stable coronary artery disease:an international,randomised,double-blind,placebo-controlled trial[J]. Lancet,2018,391(10117):205-218.
[35] Mc Carthy CP,Vaduganathan M,Mc Carthy KJ,et al. Left ventricular thrombus after acute myocardial infarction:screening,prevention,and treatment[J]. JAMA Cardiol,2018,3(7):642-649.
[2] Dewilde WJ,Oirbans T,Verheugt FW,et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention:an open-label,randomised,controlled trial[J]. Lancet,2013,381(9872):1107-1115.
[3] Gibson CM,Mehran R,Bode C,et al. Prevention of bleeding in patients with atrial fibrillation undergoing PCI[J]. N Engl J Med,2016,375(25):2423-2434.
[4] Cannon CP,Bhatt DL,Oldgren J,et al. Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation[J]. N Engl J Med,2017,377(16):1513-1524.
[5] Weinsaft JW,Kim J,Medicherla CB,et al. Echocardiographic algorithm for postmyocardial infarction LV thrombus:a gatekeeper for thrombus evaluation by delayed enhancement CMR[J]. JACC Cardiovasc Imaging,2016,9(5):505-515.
[6] Lee JM,Park JJ,Jung HW,et al. Left ventricular thrombus and subsequent thromboembolism,comparison of anticoagulation,surgical removal,and antiplatelet agents[J]. J Atheroscler Thromb,2013,20(1):73-93.
[7] Toth C,Ujhelyi E,Fulop T,et al. Clinical predictors of early left ventricular thrombus formation in acute myocardial infarction[J]. Acta Cardiol,2002,57(3):205-211.
[8] Benichou M,Aubry J,Larbi MB,et al. Detection of left intraventricular thrombi in the acute phase of myocardial infarction by 2-dimensional echocardiography.Apropos of 103 cases[J]. Arch Mal Coeur Vaiss,1983,76(9):1012-1019.
[9] Habash F,Vallurupalli S. Challenges in management of left ventricular thrombus[J]. Ther Adv Cardiovasc Dis,2017,11(8):203-213.
[10] Shacham Y,Leshem-Rubinow E,Ben Assa E,et al. Frequency and correlates of early left ventricular thrombus formation following anterior wall acute myocardial infarction treated with primary percutaneous coronary intervention[J].Am J Cardiol,2013,111(5):667-670.
[11] Meurin P,Brandao Carreira V,Dumaine R,et al. Incidence,diagnostic methods,and evolution of left ventricular thrombus in patients with anterior myocardial infarction and low left ventricular ejection fraction:a prospective multicenter study[J]. Am Heart J,2015,170(2):256-262.
[12] Mir JU,Raheel Jahangir J,Asfandyar Q,et al. Left ventricular thrombus in patients with acute anterior wall myocardial infarction[J]. J Ayub Med Coll Abbottabad,2014,26(4):491-495.
[13] Jiang YX,Jing LD,Jia YH. Clinical characteristics and risk factors of left ventricular thrombus after acute myocardial infarction:a matched case-control study[J]. Chin Med J(Engl),2015,128(18):2415-2419.
[14] Weinreich DJ,Burke JF,Pauletto FJ. Left ventricular mural thrombi complicating acute myocardial infarction. Long-term follow-up with serial echocardiography[J]. Ann Intern Med,1984,100(6):789-794.
[15] Okuyan E,Okcun B,Dinckal MH,et al. Risk factors for development of left ventricular thrombus after first acute anterior myocardial infarction-association with anticardiolipin antibodies[J]. Thromb J,2010,8:15.
[16] Takasugi J,Yamagami H,Noguchi T,et al. Detection of left ventricular thrombus by cardiac magnetic resonance in embolic stroke of undetermined source[J].Stroke,2017,48(9):2434-2440.
[17] Acar Z,Ziyrek M,Korkmaz L,et al. Mean platelet volume at admission is a determinant of left ventricular thrombus formation after primary percutaneous coronary intervention for first anterior wall myocardial infarction[J]. Acta Cardiol,2014,69(6):603-609.
[18] Delewi R,Zijlstra F,Piek JJ. Left ventricular thrombus formation after acute myocardial infarction[J]. Heart,2012,98(23):1743-1749.
[19] Fujino M,Nakai M,Nishimura K,et al. Anticoagulation combined with antiplatelet therapy in patients with left ventricular thrombus after first acute myocardial infarction[J]. Eur Heart J,2018,39(3):201-208.
[20] Weinsaft JW,Kim RJ,Ross M,et al. Contrast-enhanced anatomic imaging as compared to contrast-enhanced tissue characterization for detection of left ventricular thrombus[J]. JACC Cardiovasc Imaging,2009,2(8):969-979.
[21] Srichai MB,Junor C,Rodriguez LL,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[J]. Am Heart J,2006,152(1):75-84.
[22] Weinsaft JW,Kim HW,Crowley AL,et al. LV thrombus detection by routine echocardiography:insights into performance characteristics using delayed enhancement CMR[J]. JACC Cardiovasc Imaging,2011,4(7):702-712.
[23] O'Gara PT,Kushner FG,Ascheim DD,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[J]. Circulation,2013,127(4):e362-425.
[24] Kernan WN,Ovbiagele B,Black HR,et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke,2014,45(7):2160-2236.
[25] Ibanez B,James S,Agewall S,et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation:The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology(ESC)[J]. Eur Heart J,2018,39(2):119-177.
[26] le May MR,Acharya S,Wells GA,et al. Prophylactic warfarin therapy after primary percutaneous coronary intervention for anterior ST-segment elevation myocardial infarction[J]. JACC Cardiovasc Interv,2015,8(1 Pt B):155-162.
[27] Shavadia JS,Youngson E,Bainey KR,et al. Outcomes and prognostic impact of prophylactic oral anticoagulation in anterior ST-segment elevation myocardial infarction patients with left ventricular dysfunction[J]. J Am Heart Assoc,2017;6(7).pii:e006054.
[28] Mehta SR,Bainey KR,Cantor WJ,et al. 2018 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology Focused Update of the Guidelines for the Use of Antiplatelet Therapy[J]. Can J Cardiol,2018,34(3):214-233.
[29] Rosendaal FR,Cannegieter SC,van der Meer FJ,et al. A method to determine the optimal intensity of oral anticoagulant therapy[J]. Thromb Haemost,1993,69(3):236-239.
[30] JCS Joint Working Group. Guidelines for Pharmacotherapy of Atrial Fibrillation(JCS 2013)[J]. Circ J,2014,78(8):1997-2021.
[31] Bjorck F,Renlund H,Lip GY,et al. Outcomes in a warfarin-treated population with atrial fibrillation[J]. JAMA Cardiol,2016,1(2):172-180.
[32] Nili M,Deviri E,Jortner R,et al. Surgical removal of a mobile,pedunculated left ventricular thrombus:report of 4 cases[J]. Ann Thorac Surg,1988,46(4):396-400.
[33] Mega JL,Braunwald E,Murphy SA,et al. Rivaroxaban in patients stabilized after a ST-segment elevation myocardial infarction:results from the ATLAS ACS-2-TIMI-51 trial(Anti-Xa Therapy to Lower Cardiovascular Events in Addition to Standard Therapy in Subjects with Acute Coronary Syndrome-Thrombolysis In Myocardial Infarction-51)[J]. J Am Coll Cardiol,2013,61(18):1853-1859.
[34] Connolly SJ,Eikelboom JW,Bosch J,et al. Rivaroxaban with or without aspirin in patients with stable coronary artery disease:an international,randomised,double-blind,placebo-controlled trial[J]. Lancet,2018,391(10117):205-218.
[35] Mc Carthy CP,Vaduganathan M,Mc Carthy KJ,et al. Left ventricular thrombus after acute myocardial infarction:screening,prevention,and treatment[J]. JAMA Cardiol,2018,3(7):642-649.