Incidence, consequences and natural history of left ventricular thrombus after acute anterior myocardial infarction (Dr Evangelos Tzolos)

In the aftermath of acute myocardial infarction, the combination of blood stasis and activated tissue factor frequently leads to the formation of left ventricular thrombus. This can result in devastating clinical sequelae including systemic thromboembolism and stroke. There is increasing evidence that a substantial number of cases with left ventricular thrombus go undetected.

We therefore need a more specific and selective imaging technique to detect left ventricular thrombus and to better understand its natural history and consequences.

As part of a unique collaboration, we have access to a clinical grade thrombus-specific radiotracer, 18F-GP1, which has a high specificity for the glycoprotein IIb/IIIa receptor on activated platelets.

Our pilot data have demonstrated that 18F-GP1 is highly sensitive to in-vivo and ex-vivo thrombus formation and demonstrates avid binding to subclinical left ventricular thrombus.

Moreover, it provides the first method for assessing whether clot formation is active, potentially differentiating old healed clot from developing thrombus.

In this fellowship, we will build on Dr Tzolos’ promising preliminary data to explore the true incidence of subclinical left ventricular thrombus following infarction, describe the natural history, time course and influence of anticoagulant therapies on thrombus formation, and to investigate the incidence and determinants of subclinical stroke.