Assessment of mitral annular velocities by Doppler tissue imaging in predicting left ventricular thrombus formation after first anterior acute myocardial infarction

This study was carried out in cardiology department, Zagazig University from Augest 2005 to December 2006.This study included 60 patients with first acute anterior myocardial infarction. These patients were 36 male (72%) and 14 female (28%).Patients included in our study represented by first time anterior wall acute myocardial infarction who met the following criteria;1) Chest pain lasting more 30 minutes.2) S-T segment elevation greater than 2 mm in two consecutive anterior electrographic leads.3) Transient elevation of biochemical cardiac markers .Patients were excluded if they had;1) Evidence of previous anterior myocardial infarction.2) Valvular heart disease.3) Patients with poor Echo window.4) Conduction abnormalities.All patients were subjected to the following:1) Complete history taking.2) Thorough physical examination.3) Laboratory tests.4) 12- lead surface ECG.5) Determination if patient was received thrombolytic therapy or not.6) Echocardiographic evaluation (M-mode, 2- dimensional and DTI assessment was performed for all patients within 24 hours of arrival to CCU to evaluate LV function & to measure mitral annular velocites then two dimensional echocardiography to detremine thrombus was formed on days 7 and 30) .The present study specifically sought to identify value of assessment of mitral annular velocities by TDE in prediction of left ventricular thrombus formation after first acute anterior myocardial infarctionPatients were divided into two groups: group I; patients with thrombus ( 19 patients ”31.6%” ) and group II; patients without LV thrombus (41 patients ”68.4%”)Result of study:Clinical and demograohic data :There was no significant difference between the two groups as regard age, gender, diabetes mellitus, hypertension, heart rate, peak CPK and weither patients were received thrombolytic therapy or not.Echocardiographic finding :LVESV and LVEDV were higher in group I than in group II while EF was lower in group I than in group II. As regard WMSI is higher in group I than in group II.E wave velocity was higher in group I than in group II, while A wave velocity was lower in group I than in group II and E/A ratio is higher in group I than in group II.Deceleration time of E wave was shorter in group I than in group II and IVRT was lower in group I than in group II.TDE finding:Em wave velocity was lower in group in than in group II, Am wave velocity had no significant difference between the two groups while Em/Am ratio was lower in grop I than in group II and E/Em ratio was higher in group I than in group II.Sm wave velocity was lower in group I than in group II.From previous data and correlation of TDE finding with other echographic data, we found that systolic and diastolic functions was impaired in patients of group I than in group II but Sm velocity and WMSI had higher sensitivity and higher specificity (94.7% sensitivity, 95.1% specificity for Sm wave velocity and 94.2% sensitivity, 90.2% specificity for WMSI).From our study, we can conclude that TDE can be used for estimation of systolic and diastolic functions of LV and hence identification of patients at high risk for LV thrombus formation after first time acute anterior myocardial infarction and we recommend more studies to support our results. Importance of role of oral anticoagulant after AMI.