Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3720_Библиотеки_им_академика_М_И_Перельмана

The type and nature of the cardiomyopathy identified at the time of the CMRI are important because it provides the basis for an underlying substrate that predisposes to clot formation. In the setting of coronary artery disease, left-ventricular thrombi adhere to the zone of infarcted myocardium. In autopsy studies of p atients with fatal myocardial infarction prior to the advent of aggressive anticoagulation and revascularization, 10% of patients had evidence of thrombus on day 1, 60% by day 7, and 90% by 1 month [9]. The incidence of cardiac thrombus reported from autopsy studies in dilated cardio­myopathy was 49%, most of which occurred in the left ventricle. The overall incidence of cardiac thrombus in the modern era of treatment for infarct and cardiomyop athy is clearly much lower. However, the observation that thrombi are more likely to occur in ischemic cardiomyopathy than in nonischemic cardiomyopathy holds true. In a study by Weinsaft et al., 784 consecutive patients with systolic dysfunction undergoing CMRI for evaluation of viability, in the case of ischemic cardiomyopathy, and characteristic scar patterns to identify type of nonischemic cardiomyopathy were reviewed [8]. Thrombus was identified in 7% of patients with delayed enhancement CMRI. Of those, 80% were in the apex. In the study, patients with thrombus were more likely to have an underlying ischemic cardiomyopathy (9.2% vs. 1.7%, P ¼ .0002) despite a similar mean ejection fraction consistent with historical data. The likelihood of thrombus increased with an ejection fraction less than or equal to 30%, and was as high as 14% in ischemic cardiomyopathy with a left-ventricular ejection fraction less than or equal to 30%, and 3% in nonischemic cardiomyopathy with a left-ventricular ejection fraction less than or equal to 30%. Scar size and prevalence were markedly higher in those with thrombus versus those