Portal de Periódicos da CAPES

Left ventricular thrombus and stroke after myocardial infarction: Toward prevention or perplexity?

1989; Elsevier BV; Volume: 14; Issue: 4 Linguagem: Inglês

10.1016/0735-1097(89)90464-6

1558-3597

Jonathan L. Halperin, Valentı́n Fuster,

Cardiovascular Function and Risk Factors

Cardiogenic cerebral thromboembolism is responsible for about 15% of all cases of ischemic stroke-not as many as attributed to thrombotic or embolic complications of cerebrovascular disease, but still the cause of disabling stroke in >75,000 Americans annually (1). As we recently reviewed (2), cardiac diseases underlying these events involve atria1 fibrillation in about half the cases and valvular heart disease or left ventricular mural thrombus in the remainder (1,3). Sixty percent of emboli of left ventricular origin are a consequence of acute myocardial infarction (1,4), accounting for 15,000 to 25,000 embolic strokes each year. Several studies suggest that the risk is highest in the first 1 to 3 months after infarction and perhaps even greater in the first 10 days for patients with a large anterior infarct who have a 30% to 40% chance of developing ventricular thrombus and about a 5% risk of embolism (4,5). In addition, those who survive become part of a larger population of patients with chronic ventricular dysfunction in whom the potential for embolism is persistent (6). Left ventricular thromhus in acute myocardial infarction. In patients with myocardial infarction, >90% of ventricular thrombi occur when the anterior wall becomes hypokinetic or akinetic, enlarging the apical zone of intraventricular stasis. Inflammatory changes at the endocardial surface and enhanced thrombogenicity are additional reasons thromboembolism occurs most frequently within the first 10 days of a coronary event, although the tendency to thrombus formation may persist during the first 1 to 3 months. Infarct size seems directly related to thromboembolic risk, and the incidence of left ventricular thrombus during the early postinfarction period exceeds 50% in those with anteroapical