Peak apical rotation independently predicts left ventricular thrombus following anterior myocardial infarction

Abstract Aim To evaluate the predictive and discriminatory value of peak apical rotation for LV thrombus formation following anterior MI. Methods and results In a multicentre prospective observational study, peak apical rotation was quantified post-hoc in 270 patients presenting with anterior MI using speckle tracking echocardiography. LV thrombus was identified by echocardiography or CMR during index admission or follow-up. Associations were evaluated using multivariable regression models and discrimination assessed using receiver-operating characteristic analysis. LV thrombus was identified in 33% of the eligible patients. Peak apical rotation was significantly lower in patients with thrombus (5.0° vs 9.8°, p < 0.001). After multivariate adjustment, higher apical rotation was independently protective against thrombus (OR 0.45, p < 0.001), corresponding to an approximately 2-fold increase in thrombus odds for every 1° reduction in rotation. Admission apical rotation also independently predicted delayed thrombus development (0.46, p < 0.001). Apical rotation demonstrated superior discrimination for thrombus compared to LVEF (AUC: 0.91 vs 0.62, p < 0.001), maintaining accuracy within the LVEF ≤40% subgroup (AUC: 0.89 vs 0.48, p < 0.001). Conclusion Impaired peak apical rotation independently predicts and discriminates LV thrombus following anterior MI, outperforming global systolic parameters. Prospective validation is required to establish apical rotation as a tool for risk stratification.