Apical rotation predicts left ventricular thrombus after anterior myocardial infarction

A multicentre prospective observational study evaluated peak apical rotation as a predictor of left ventricular (LV) thrombus after anterior myocardial infarction. Investigators quantified rotation post-hoc using speckle tracking echocardiography in 270 patients. Thrombus was identified by echocardiography or cardiac magnetic resonance imaging during the index admission or follow-up, with associations assessed using multivariable regression and discrimination assessed using receiver-operating characteristic analysis.

LV thrombus was identified in 33% of eligible patients. Peak apical rotation was lower in patients with thrombus than in those without it (5.0° versus 9.8°; p<0.001). Higher rotation was independently associated with lower thrombus odds after adjustment (odds ratio 0.45; p<0.001). Admission rotation also independently predicted delayed thrombus development. Discrimination exceeded that of LV ejection fraction (LVEF), with areas under the curve of 0.91 versus 0.62 overall and 0.89 versus 0.48 among patients with LVEF ≤40% (both p<0.001).

These findings suggest apical rotation may provide additional information for thrombus risk stratification beyond global systolic function. However, this was a post-hoc observational analysis, and prospective validation is required before clinical adoption. Only the abstract was available; confidence intervals, detailed adjustment variables, and follow-up duration were not provided.