Authors:

Minh Thien Pham

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Background: Apical thrombi in patients with anterior wall ST-segment elevation myocardial infarction (AWMI) or dilated cardiomyopathy (DilCM) are associated with embolic complications, including stroke. The morphology and composition of these thrombi may influence embolic risk. This study aimed to determine which thrombus characteristics are associated with higher embolic potential and clinical outcomes. Methods: This retrospective study included 32 patients diagnosed with apical thrombus via echocardiography between 2010 and 2021. Twelve patients had AWMI and 20 had DilCM. Patients with atrial fibrillation were excluded. Data collected included time from thrombus detection to stroke, type of anticoagulation (i.e., vitamin K antagonists vs. NOACs), and clinical response. Thrombi were analyzed for size, shape, protrusion, and echogenicity. Chi square or Fisher's exact test was used to compare outcomes. Results: Three of 12 patients with AWMI (25%) developed stroke within a mean of 7.5 days. These thrombi were small, round, protruding, and heterogeneous in echogenicity. Stroke events in this group were generally mild, with good recovery after thrombolysis. In the DilCM group, 2 of 20 patients (10%) developed stroke at a mean of 21 days (p < 0.05). These thrombi were larger, flat, incorporated into the apical wall, and had homogeneous echogenicity. Strokes in this group were more severe and less responsive to treatment. Conclusion: Thrombi in AWMI patients, though more embolic, were associated with better outcomes due to favorable morphology. Thrombi in DilCM patients † Presenting Undergrad Author; ‡ Contributing Undergrad Author; * Undergrad Acknowledgment were less embolic but led to worse clinical outcomes. Larger studies are needed to confirm these findings. Keywords: Dilated Cardiomyopathy; Anterior Wall St-Segment Elevation; Myocardial Infarction; Thrombi; Embolic Risk

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Purdue University / 2025

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Co-authors:

Minh Thien Pham