TOPLINE

Low peak apical rotation on speckle-tracking transthoracic echocardiography (TTE) during admission was independently associated with left ventricular (LV) thrombus after anterior myocardial infarction (MI), including thrombus that developed later, and discriminated thrombus better than LV ejection fraction (LVEF), an analysis of a prospective, observational study showed.

METHODOLOGY

• This prospective, observational study included data of 270 patients with anterior MI and echocardiograms adequate for speckle tracking. The patients were screened at two UK centres between 2024 and 2026.
• LV thrombus was diagnosed on TTE, with contrast-enhanced echocardiography or cardiac magnetic resonance (CMR) added when clinically warranted; LV thrombi were found in 89 patients: 52 at the admission scan and 37 at follow-up.
• All patients without LV thrombus on admission underwent follow-up imaging after a median of 61 days to identify delayed thrombus formation.
• The researchers measured peak apical rotation post hoc using two-dimensional speckle-tracking echocardiography of apical short-axis images.
• They also assessed associations of apical rotation with thrombus and LVEF, evaluated discrimination, and identified optimal cutoffs, with sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) reported at selected cutoffs.

TAKEAWAY

• Patients with thrombus had lower median peak apical rotation than those without (5.0° vs 9.8°; P < .001). In the multivariate analysis, every 1° increase in peak apical rotation was independently associated with lower odds of LV thrombus (adjusted odds ratio [aOR], 0.45; P < .001).
• In patients who had no thrombus at the first scan, lower peak apical rotation at admission independently predicted thrombus at follow-up (aOR, 0.46; P < .001); their values were similar to those of patients whose thrombus was already visible at admission (4.6° vs 5.0°; P = .377).
• Apical rotation correlated modestly with LVEF in patients without thrombus (correlation coefficient [r] = 0.34; P < .001), whereas no association was observed in patients with thrombus (r = 0.04; P = .700), in whom rotation remained low irrespective of LVEF.
• Apical rotation discriminated thrombus better than LVEF (area under the curve [AUC], 0.91 vs 0.62; P < .001), a difference that persisted in patients with LVEF of 40% or less (AUC, 0.89 vs 0.48). In the overall cohort, a cutoff of 8.6° yielded a sensitivity of 94.3% and a specificity of 73.4%, and a 7.5° cutoff in the subgroup with LVEF of 40% or less achieved a sensitivity of 87.1% and a specificity of 74.8%, with a PPV of 67.3% and an NPV of 90.7%.

IN PRACTICE

"Impaired peak apical rotation is independently associated with LV thrombus formation following anterior MI and provides greater discrimination than conventional measures of systolic function," the authors wrote.

"[I]t identifies high-risk patients even within the subgroup with severely reduced LVEF and appears abnormal before thrombus becomes clinically apparent," they added.

SOURCE

The study was led by Johanna Jones, Queen Mary University of London, London, UK. It was published online on September 29, 2026, in European Heart Journal - Cardiovascular Imaging.

LIMITATIONS

The study was limited by the exclusion of screened patients whose echocardiographic images were inadequate for speckle-tracking analysis, follow-up imaging that varied in modality and timing (CMR performed in 40.4% of those followed up and TTE in the rest), and apical rotation cutoffs derived within the same cohort without external validation. The observational design of the study prevented the establishment of causality.

DISCLOSURES

Funding information was not provided for the study. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.