Risk factors for development of left ventricular thrombus after first acute anterior myocardial infarction-association with anticardiolipin antibodies

<p>Abstract</p> <p>Background</p> <p>Left ventricular thrombus(LVT] formation is a frequent complication in patients with acute anterior myocardial infarction(MI). LVT is associated with increased risk of embolism and higher mortality rates after acute MI. Anticardiolipin antibodies (ACA) are immunoglobulins that react with phospholipid-binding proteins interfering with the prothrombin activator complex. The effects of phospholipids on pathophysiology of cardiovascular thrombotic events are well known. In this study, we aimed to evaluate the importance of clinical and biochemical parameters including anticardiolipin antibodies on left ventricular thrombus formation after acute anterior MI.</p> <p>Methods and Results</p> <p>Seventy patients with a first anterior AMI were prospectively and consecutively enrolled. Patients with previous MI, autoimmune disease, collagen vascular disease and arterial or venous thrombosis history were excluded from this study. At the time of hospitalization, key demographic and clinical characteristics were collected including age, gender, ethanol intake and presence of traditional risk factors for atherosclerosis (hypertension, diabetes, smoking, hyperlipidemia, positive family history). Patients were evaluated for echocardiographic data, blood chemistry and ACA. Two-dimensional and Doppler echocardiographic examinations were performed in all patients within the first week and at 14 days after MI. LV thrombus was detected in 30 (42.8%) patients. ACA IgM levels were significantly higher in the patient group with LV thrombus than in the group without thrombus (12.44 ±4.12 vs. 7.69 ± 4.25 mpl, p = 0,01). ACA IgG levels were also found higher in the group with LV thrombus (24.2 ± 7.5 vs.17.98 ± 6.45 gpl, p = 0.02). Multivariate analyses revealed diabetes mellitus, higher WMSI, lower MDT and higher ACA IgM and higher ACA IgG levels as independent predictors of left ventricular thrombus formation.</p> <p>Conclusions</p> <p>Our data demonstrate that beside the low ejection fraction, lower MDT and higher wall motion score index, modestly elevated ACA IgM and ACA IgG levels are associated with LV thrombus formation in patients with anterior MI.</p

INVEST: INternational VErapamil SR Trandolapril STudy

This study has been completed. Sponsor: University of Florida Collaborator: Abbott Information provided by (Responsible Party): University of Florida ClinicalTrials.gov Identifier: NCT00133692 First received: August 22, 2005 Last updated: September 16, 2011 Last verified: August 2010 History of Changes Full Text View Tabular View No Study Results Posted Disclaimer How to Read a Study Record Purpose Because blood pressure affects the heart, blood vessels, kidneys, and the entire body, it is important to keep it as normal as possible. There are several different ways to control blood pressure and to prevent or limit the development of heart disease due to high blood pressure. The purpose of this study is to compare two treatments to see how well they work and the difference in their side effects. One treatment includes the use of a calcium antagonist drug (Isoptin sustained release [SR] or Verapamil SR). The other treatment excludes the calcium antagonist and may include a non-calcium antagonist drug called a beta blocker (Tenormin or Atenolol). Both treatments may also include medication called angiotensin converting enzyme (ACE) inhibitors and water pills. None of the drugs in this study are experimental, they are all approved by the Food and Drug Administration (FDA). Condition Intervention Phase Hypertension Coronary Artery Disease Drug: Verapamil SR/Trandolapril/Hydrochlorothiazide (HCTZ) Drug: Atenolol/HCTZ/Trandolapril Phase 4 Study Type: Interventional Study Design: Allocation:Randomized EndpointClassification:Safety/EfficacyStudy InterventionModel:ParallelAssignment Masking:OpenLabel PrimaryPurpose:Treatment Official Title: INternational VErapamil SR Trandolapril STudy Resource links provided by NLM: MedlinePlus related topics: HighBloodPressure Drug Information available for: Hydrochlorothiazide Verapamilhydrochloride Atenolol Trandolapril U.S. FDA Resources Further study details as provided by University of Florida: Primary Outcome Measures: First occurrence of death or nonfatal myocardial infarction (MI) or nonfatal stroke Secondary Outcome Measures: Death Nonfatal MI Nonfatal stroke Newly diagnosed diabetes BP control Cancer Gastrointestinal (GI) bleeding Alzheimer&#39;s Disease Parkinson&#39;s Disease Cardiovascular (CV) hospitalizations Quality of life Compliance Estimated Enrollment: 22000 Study Start Date: September 1997 Estimated Study Completion Date: February 2003 Detailed Description: INVEST is an investigator initiated international, prospective, randomized study comparing two pharmacotherapy strategies to control hypertension in ambulatory patients with coronary artery disease (CAD). One strategy, the calcium antagonist care strategy, centers on a calcium antagonist (verapamil SR) followed by addition of an ACE inhibitor (trandolapril) and then diuretic (hydrochlorothiazide) as needed to achieve target blood pressures (BP). The other strategy, the non-calcium antagonist care strategy, uses a beta-blocker (atenolol) followed by addition of low-dose diuretic and then an ACE inhibitor (trandolapril) as needed to reach target BP. In either strategy additional drugs can be added provided the calcium antagonist is retained in the calcium antagonist care strategy and calcium antagonists are omitted in the non-calcium antagonist care strategy. The study is organized into 15 international regions with about 1,500 study investigators randomizing approximately 22,000 patients who will be treated for at least two years. The primary response variable is the occurrence of adverse outcome, defined as any of the following events: all cause mortality, nonfatal MI or nonfatal stroke. A number of secondary response variables, including newly diagnosed diabetes will also be evaluated. The primary objective of this trial is to examine the hypothesis that the risk for adverse outcomes (all cause mortality, nonfatal MI or nonfatal stroke) in hypertensive patients with CAD is at least equivalent during treatment of hypertension with a calcium antagonist strategy when compared with a non-calcium antagonist strategy