A study headed by the INCLIVA Health Research Institute, the Hospital Clínic Universitari de València and the Cardiovascular Diseases Area of the Centre for Biomedical Research Network (CIBERCV) has developed an innovative model to predict left ventricular thrombus after an acute myocardial infarction. The study was carried out in collaboration with the Vall d'Hebron University Hospital and the Vall d'Hebron Research Institute (VHIR), the Complejo Asistencial Universitario de Salamanca (CAUSA), the Instituto de Investigación Biomédica de Salamanca (IBSAL), the Hospital Clínico Universitario de Salamanca and the Hospital Clínic de Barcelona.

Left ventricular thrombus is a serious and potentially lethal complication that can occur after an acute myocardial infarction. It is difficult to accurately detect it, and the patients who should be screened and monitored most closely are yet to be fully defined. This study developed an action plan that would allow resources to be efficiently allocated to the patients most at risk.

The study, headed by Dr Víctor Marcos Garcés, researcher of the Translational Research Group in Ischemic Cardiopathy of INCLIVA and CIBERCV and research cardiologist of CIBER who also works at the Post-infarction Cardiac Rehabilitation Unit of the Hospital Clínic Universitari de València, concludes that left ventricular thrombus can be predicted in the first 6 months after the infarction based on variables that are easily identified before hospital discharge. The results demonstrate that 20% of patients in the highest risk group develop a left ventricular thrombus.

A serious complication

“Left ventricular thrombus is a serious complication that significantly increases the risk of stroke and death, even years after a myocardial infarction. Although cardiac ultrasound is a commonly used tool, there are limitations to this procedure, as up to half of the thrombi can go unnoticed using this technique,” explained Dr Carlos Bertolín Boronat, cardiologist and main author of the study. “While cardiac magnetic resonance imaging offers greater precision, its high cost and limited availability make widespread implementation difficult,” he added.

The study, carried out at the Hospital Clínic Universitari de València, provides a promising solution for optimising the detection of these thrombi and moving towards precision medicine. The study involved 590 patients with acute myocardial infarction who were assessed during hospital admission using their medical history, electrocardiograms and cardiac ultrasound scans. They then underwent cardiac magnetic resonance imaging to thoroughly analyse the structure and function of their heart, making it possible to detect the ventricular thrombus more reliably.

“The results of the study are encouraging. By conducting routine assessments during hospital admission, we can now assign an individualised probability of developing a left ventricular thrombus in the first six months after the heart attack,” commented Dr Víctor Marcos Garcés, a CIBERCV research cardiologist who works at the Post-infarction Cardiac Rehabilitation Unit of the Hospital Clínic Universitari de València forms part of the team that conducts cardiac magnetic resonance imaging scans at the centre, in collaboration with the Radiodiagnostic Service.

“This approach would allow more cases to be identified at an early stage, reducing the associated complications and optimising the resources available. More specifically, we propose prioritising magnetic resonance imaging in those patients in the highest risk group, as this will allow us to strike a balance between diagnostic efficacy and economic sustainability,” he concluded.

The conclusions of the study, which have been presented at several national and international conferences, offer a new perspective on the management of post-infarction complications, underscoring the importance of personalising diagnostic resources according to the individual risk of each patient.

Doctors Carlos Bertolín Boronat and Vicente Bodí from INCLIVA, the Hospital Clínic Universitari de València and the Universitat de Valencia (UV) also participated in the study. Dr José Fernando Rodríguez-Palomares, head of the Cardiovascular Imaging Unit of the Heart Knowledge Area of the Vall d'Hebron University Hospital of Barcelona and principal investigator of the Cardiovascular Diseases Group of the Vall d'Hebron Research Institute (VHIR); Pedro L. Sánchez, Candelas Pérez del Villar and Cristian Herrera of the Cardiology Service of the Complejo Asistencial Universitario de Salamanca and researchers of the Biomedical Research Institute of Salamanca; and Blanca Domenech-Ximenos and José T. Ortiz-Pérez of the Hospital Clínic de Barcelona also spoke at the event. The four institutions collaborate within the Biomedical Research Centre Network (CIBER) consortium.

The results of this study, which has received funding through a GE 2023 grant from the Ministry of Education, Culture, Universities and Employment of the Generalitat Valenciana (CIGE/2022/26) and the Carlos III Health Institute (CI-BERCV16/11/00486), have been published in the prestigious European Journal of Internal Medicine under the title "Prediction of Left Ventricular Thrombus After Myocardial infarction: A Cardiac Magnetic Resonance-based Prospective Registry."