Dataset Information

Diffuse LAD and LV Thrombus as Possible Manifestation of Protein-S Deficiency in a Young Patient.

ABSTRACT: Patients with inherited hypercoagulopathies such as protein-S deficiency commonly present with venous thrombosis. However, there are rare cases of arterial thrombosis. We describe a rare case of a diffuse left anterior descending and left ventricular thrombus in a young patient with protein-S deficiency complicated with mid cerebral artery occlusion. (Level of Difficulty: Intermediate.).

SUBMITTER: Kalogeras K

PROVIDER: S-EPMC10442610 | biostudies-literature | 2023 Aug

REPOSITORIES: biostudies-literature

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Diffuse LAD and LV Thrombus as Possible Manifestation of Protein-S Deficiency in a Young Patient.

Kalogeras Konstantinos K Kyvelou Stella-Maria SM Vythoulkas-Biotis Nikolaos N Pesiridis Theodoros T Vogiatzi Georgia G Katsianos Efstratios E Vavuranakis Michael Andrew MA Oikonomou Evangelos E Siasos Gerasimos G Vavuranakis Manolis M

JACC. Case reports 20230816

Patients with inherited hypercoagulopathies such as protein-S deficiency commonly present with venous thrombosis. However, there are rare cases of arterial thrombosis. We describe a rare case of a diffuse left anterior descending and left ventricular thrombus in a young patient with protein-S deficiency complicated with mid cerebral artery occlusion. (<b>Level of Difficulty: Intermediate.</b>). ...[more]

PMID: 37614329

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Project description:ObjectivesThe goal of this study was to determine the prevalence of post-myocardial infarction (MI) left ventricular (LV) thrombus in the current era and to develop an effective algorithm (predicated on echocardiography [echo]) to discern patients warranting further testing for thrombus via delayed enhancement (DE) cardiac magnetic resonance (CMR).BackgroundLV thrombus affects post-MI management. DE-CMR provides thrombus tissue characterization and is a well-validated but an impractical screening modality for all patients after an MI.MethodsA same-day echo and CMR were performed according to a tailored protocol, which entailed uniform echo contrast (irrespective of image quality) and dedicated DE-CMR for thrombus tissue characterization.ResultsA total of 201 patients were studied; 8% had thrombus according to DE-CMR. All thrombi were apically located; 94% of thrombi occurred in the context of a left anterior descending (LAD) infarct-related artery. Although patients with thrombus had more prolonged chest pain and larger MI (p ≤ 0.01), only 18% had aneurysm on echo (cine-CMR 24%). Noncontrast (35%) and contrast (64%) echo yielded limited sensitivity for thrombus on DE-CMR. Thrombus was associated with stepwise increments in basal → apical contractile dysfunction on echo and quantitative cine-CMR; the echo-measured apical wall motion score was higher among patients with thrombus (p < 0.001) and paralleled cine-CMR decrements in apical ejection fraction and peak ejection rates (both p < 0.005). Thrombus-associated decrements in apical contractile dysfunction were significant even among patients with LAD infarction (p < 0.05). The echo-based apical wall motion score improved overall performance (area under the curve 0.89 ± 0.44) for thrombus compared with ejection fraction (area under the curve 0.80 ± 0.61; p = 0.01). Apical wall motion partitions would have enabled all patients with LV thrombus to be appropriately referred for DE-CMR testing (100% sensitivity and negative predictive value), while avoiding further testing in more than one-half (56% to 63%) of patients.ConclusionsLV thrombus remains common, especially after LAD MI, and can occur even in the absence of aneurysm. Although DE-CMR yielded improved overall thrombus detection, apical wall motion on a noncontrast echocardiogram can be an effective stratification tool to identify patients in whom DE-CMR thrombus assessment is most warranted. (Diagnostic Utility of Contrast Echocardiography for Detection of LV Thrombi Post ST Elevation Myocardial Infarction; NCT00539045).

Dataset Information

Diffuse LAD and LV Thrombus as Possible Manifestation of Protein-S Deficiency in a Young Patient.

Publications

Diffuse LAD and LV Thrombus as Possible Manifestation of Protein-S Deficiency in a Young Patient.

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