Impact of residual thrombus burden on ventricular deformation after acute myocardial infarction: A sub-analysis from an intravascular optical coherence tomography study

Jinying Zhou; Shiqin Yu; Peng Zhou; Chen Liu; Zhaoxue Sheng; Jiannan Li; Runzhen Chen; Hongbing Yan; Shihua Zhao

doi:10.1016/j.eclinm.2021.101058

Impact of residual thrombus burden on ventricular deformation after acute myocardial infarction: A sub-analysis from an intravascular optical coherence tomography study

EClinicalMedicine. 2021 Jul 31:39:101058. doi: 10.1016/j.eclinm.2021.101058. eCollection 2021 Sep.

Authors

Jinying Zhou¹, Shiqin Yu¹, Peng Zhou^{1

2}, Chen Liu^{1

2}, Zhaoxue Sheng¹, Jiannan Li¹, Runzhen Chen¹, Hongbing Yan^{1

2

1}, Shihua Zhao¹

Affiliations

¹ Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China.

Abstract

Background: Coronary residual thrombus before stenting in ST-segment elevation myocardial infarction (STEMI) has been linked to microvascular injury but its impact on ventricular deformation and cardiac dysfunction in longer term remains unclear.

Methods: This was a post-hoc sub-analysis from an optical coherence tomography registry. Residual thrombus before stenting was measured geometrically and maximal thrombus-to-lumen area ratio (MTR) was reported. Cardiovascular magnetic resonance (CMR) follow-ups were performed at 30 days post STEMI. The primary outcomes were CMR-derived parameters including left ventricular ejection fraction (LVEF), infarct size, microvascular obstruction (MVO), and left ventricular global strains in radial (GRS), circumferential (GCS), longitudinal (GLS) directions.

Findings: From March 2017 to March 2019, forty-two patients with first-ever anterior STEMI were included. Average CMR follow-up time was 33 (IQR 30-37) days. In multivariable analysis, MTR was significantly associated with LVEF (per 10%, adjusted β = -1·96, 95%CI -3·66 to -0·26), MVO (per 10%, adjusted β = 0·07, 95%CI 0·01 to 0·13), GRS (per 10%, adjusted β = -1·26, 95%CI -2·28 to -0·23), and GCS (per 10%, adjusted β = 0·53, 95%CI 0·01 to 1·06). However, it was not related to GLS (per 10%, adjusted β = 0·29, 95%CI -0·85 to 1·43) or infarct size (per 10%, adjusted β = 0·07, 95%CI -0·40 to 0·55).

Interpretation: Larger residual thrombus burden was associated with worse GRS and GCS but not GLS after a first anterior myocardial infarction.

Funding: This work was supported by Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (2016-I2M-1-009), National Natural Science Foundation of China (81,970,308, 81,930,044, and 81,620,108,015), Sanming Project of Medicine in Shenzhen (SZSM201911017), and Shenzhen Key Medical Discipline Construction Fund (No. SZXK001).

Keywords: Cardiac magnetic resonance; Optical coherence tomography; ST elevation myocardial infarction; Thrombosis; ventricular function.