Left ventricular ejection fraction changes in patients with, and without, LV thrombus on CMR were 2.7% (IQR -1.4C6.7%) compared to 5.0% (IQR 1.4C7.8%); em p /em ? ?0.02 and on echocardiography were 0.7% (IQR -2.9-3.2%) compared to 4.5% (IQR 1.2C9.0%); em p /em ?=?0.006. All patients with LV thrombus were treated with oral anticoagulation with warfarin. Logistic regression using a stepwise model was used to determine predictors of LV thrombus. Variables were selected based on significance on univariate analysis. Receiver-operator characteristic curves were used to assess the performance of test parameters in predicting LV thrombus. All tests were 2-tailed, and em p /em -values???0.05 were considered statistically significant. 3.?Results During the study period, 409 consecutive STEMI patients were screened from May 2012 to June 2014, of which 265 were enrolled in our study (72 declined participation, 28 could not consent due to language barriers, 15 died prior to consent, 12 had chronic renal failure, 5 had prior cardiothoracic surgery and 12 were excluded for various reasons). A further 29 patients could not undergo CMR, 12 withdrew consent, 8 did not have paired CMR data and 6 were lost to follow-up (see Appendix 1); resulting in 210 patients being included in this paired CMR study. The clinical characteristics are shown in Table 1. Table 1 Baseline characteristics. thead th rowspan=”1″ colspan=”1″ /th MA242 th rowspan=”1″ colspan=”1″ Overall ( em n /em ?=?210) /th th rowspan=”1″ colspan=”1″ LV Thrombus + ( em n /em ?=?26) /th th rowspan=”1″ colspan=”1″ LV Thrombus – ( em n /em ?=?184) /th th rowspan=”1″ colspan=”1″ p MA242 /th /thead Male sex, n (%)179 (85)22 (85)157 (84)0.92Hypertension, n (%)99 (47)15 (58)84 (46)0.25Hypercholesterolaemia, n (%)96 (46)13 (50)83 (45)0.64Diabetes mellitus, n (%)41 (20)5 (19)36 (20)0.97Smoker, n (%)121 (58)14 (54)107 (58)0.66Family history of CAD, n (%)52 (25)5 (19)47 (26)0.49First MI, n (%)191 (91)21 (81)170 (92)0.053Beta-blocker, n (%)198 (94)26 (100)172 (93)0.2ACE inhibitor/angiotensin receptor blocker, n (%)174 (83)19 (73)155 (84)0.16Statin, n (%)205 (98)24 (92)181 (98)0.058Loop diuretic, n (%)15 (7)6 (23)9 (5)0.001Mineralocorticoid antagonist, n (%)11 (5)6 (23)5 (3) 0.001DAPT, n (%)210 (100%)26 (100%)184 (100%)nsAnterior STEMI, n (%)115 (55)22 (85)93 (51)0.001Primary PCI, n (%)168 (80)23 (88)145 (79)nsSuccessful Thrombolysis, n (%)27 (13)2 (8)25 (14)nsRescue PCI, n (%)15 (7)1 (4)14 (8)ns Open in a separate window CAD?=?coronary artery disease. DAPT?=?dual antiplatelet therapy. STEMI?=?ST-segment myocardial infarction. ACE?=?angiotensin-converting enzyme. PCI?=?percutaneous coronary intervention. ns?=?not significant. Patients underwent CMR studies at a median of 4?days (IQR 3-7) and 55?days (IQR 46-64) post-STEMI. Baseline and follow up echocardiograms were performed at a median of 4?days (IQR 3-7) and 54?days (IQR 46-64). The incidence of LV thrombus by CMR was 12.3% (26/210). The incidence of LV thrombus by two-dimensional echocardiography was only 6.2% (13/210). Two-dimensional echocardiography detected LV thrombus with 50% sensitivity and 100% specificity when compared with CMR; all patients who had thrombus detected on echocardiography had a thrombus visualised on CMR. In 22 of 26 (85%) patients, LV thrombus was identified on the baseline CMR, whereas in 4 (15%), LV thrombus was only detected on their follow-up CMR. The typical CMR appearance of LV thrombus is shown in Fig. 1. Open in a separate window Fig. 1 Typical CMR appearance of LV thrombus in a patient presenting with an anterior territory STEMI, on delayed gadolinium MGC102762 enhancement (left); and early gadolinium enhancement (right). In our cohort with LV thrombus 22/26 (85%) of patients had anterior STEMI. LV thrombus was detected in 23.6% of patients with anterior STEMI (22/93). In the remaining 4 patients, 1 patient presented with an inferior territory STEMI, but had prior anterior territory myocardial infarction and experienced a new apically located thrombus. The additional 3 individuals had inferior territory STEMI with infero-apical wall motion abnormalities MA242 with apically located LV thrombi. Individuals with and without LV thrombus did not differ with respect to gender, cardiovascular risk factors or treatment modality. All individuals were treated with dual antiplatelet therapy. The pace of.