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Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Assessing the Value of Routine Contrast Echocardiography for Left Ventricular Thrombus Screening in Anterior ST-Elevation Myocardial Infarction Patients
Session:
Sessão de Posters 05 - Ecocardiografia
Speaker:
Vanda Neto
Congress:
CPC 2024
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Cartazes
FP Number:
---
Authors:
Vanda Devesa Neto; João Fiúza; Gonçalo Ferreira; Mariana Almeida; Joana Correia; Inês Pires; Emanuel Correia; Davide Moreira; Miguel Correia; Nuno Craveiro; António Costa
Abstract
<h3 style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Calibri Light",sans-serif">Background:</span></strong><span style="font-family:"Calibri Light",sans-serif"> Left ventricular (LV) thrombus is more prevalent in anterior STEMI in compared to other types of acute myocardial infarction. Contrast echocardiography (TTE) has demonstrated potential in improving diagnostic accuracy, <span style="color:#374151">impacting treatment decisions related to antithrombotic therapy versus oral anticoagulation. This study aims to evaluate the efficacy of contrast TTE as a routine screening method for detecting LV thrombus during the acute phase of anterior STEMI.</span></span></span></span></h3> <h3 style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Calibri Light",sans-serif">Methods:</span></strong><span style="font-family:"Calibri Light",sans-serif"> A single center randomized controlled trial was conducted on consecutive patients with anterior STEMI admitted to the cardiology department between November 2021 and February 2023. The study group underwent routine contrast TTE, while the control group followed a conventional approach. Conventional approach involved regular TTE, with contrast administered if thrombus suspicion arose. Demographical, clinical and diagnostic data were collected. <span style="color:#374151">Thrombus identification rates were compared between groups, and demographic, clinical, and diagnostic data were collected. Chi-squared and Mann-Whitney U tests were used for categorical and mean comparisons, respectively.</span></span></span></span></h3> <h3 style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Calibri Light",sans-serif">Results:</span></strong><span style="font-family:"Calibri Light",sans-serif"> 72 patients were included in this study (50% in each group). 76% (55) were male. Mean age was 66.1±13.5 years. The median interval from admission to the echocardiographic was 4 days (IQR 3) for both groups. Late presentation occurred in 6.7% and 10.5% of the patients in the study and control group, respectively. Across the entire patient cohort, a successful reperfusion was observed in 92.6% of cases. The median length of hospital stay was 6 days for both groups. Thrombus was detected in 24% of population. <span style="color:#374151">Routine contrast echocardiography significantly improved thrombus detection compared to the conventional approach (14% vs. 33%; p=0.047; χ² 3.78). </span></span>Thrombus detection was not significantly associated with fibrinolysis (p=0.08). No significant differences were observed in LV ejection fraction (p=0.95) or LV volume (p=0.27) between the groups. Thrombus presence was significantly associated with apical aneurysm (p<0.01; x2 7.18; 0% vs. 36%). <span style="font-family:"Calibri Light",sans-serif"> <span style="color:#374151">In-hospital mortality was 1.5% (n=1). </span></span></span>There were no notable variations between groups in terms of 6-month mortality or occurrence of stroke events (p=0.87). Additionally, no significant incidents of hemorrhage were identified during the follow-up period for either group.</span></h3> <h3 style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Calibri Light",sans-serif">Discussion:</span></strong><span style="font-family:"Calibri Light",sans-serif"> <span style="color:#374151">The routine use of contrast echocardiography significantly improved thrombus detection in anterior STEMI patients. Thrombus detection during the acute phase did not correlate with adverse outcomes during hospitalization or in the 6-month follow-up period.</span></span></span></span></h3>
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