Peak apical rotation independently predicts left ventricular thrombus following anterior myocardial infarction

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ID: 329997
2026
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Abstract
Abstract Aim To evaluate the predictive and discriminatory value of peak apical rotation for LV thrombus formation following anterior MI. Methods and results In a multicentre prospective observational study, peak apical rotation was quantified post-hoc in 270 patients presenting with anterior MI using speckle tracking echocardiography. LV thrombus was identified by echocardiography or CMR during index admission or follow-up. Associations were evaluated using multivariable regression models and discrimination assessed using receiver-operating characteristic analysis. LV thrombus was identified in 33% of the eligible patients. Peak apical rotation was significantly lower in patients with thrombus (5.0° vs 9.8°, p < 0.001). After multivariate adjustment, higher apical rotation was independently protective against thrombus (OR 0.45, p < 0.001), corresponding to an approximately 2-fold increase in thrombus odds for every 1° reduction in rotation. Admission apical rotation also independently predicted delayed thrombus development (0.46, p < 0.001). Apical rotation demonstrated superior discrimination for thrombus compared to LVEF (AUC: 0.91 vs 0.62, p < 0.001), maintaining accuracy within the LVEF ≤40% subgroup (AUC: 0.89 vs 0.48, p < 0.001). Conclusion Impaired peak apical rotation independently predicts and discriminates LV thrombus following anterior MI, outperforming global systolic parameters. Prospective validation is required to establish apical rotation as a tool for risk stratification.
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Authors Johanna Jones, Bianca Maria Coldea, Haroun Butt, Elly El-Rekaby, Abhishek Joshi, Krishnaraj Sinhji Rathod, Richard E. Jones, Thomas R. Keeble, Guy Lloyd, Anthony Mathur, Daniel A. Jones
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Journal European Heart Journal - Cardiovascular Imaging
Year 2026
DOI
10.1093/ehjci/jeag272
URL
https://doi.org/10.1093/ehjci/jeag272
Keywords Keywords not found

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