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Thromb Haemost 2011; 105(02): 356-364
DOI: 10.1160/TH10-07-0449
Cardiovascular Biology and Cell Signalling
Schattauer GmbH

Role of intramural platelet thrombus in the pathogenesis of wall rupture and intra-ventricular thrombosis following acute myocardial infarction

Xiao-Jun Du
1   Baker IDI Heart and Diabetes Institute, Central Clinical School, Monash University, Melbourne, Australia
,
Leonard Shan
1   Baker IDI Heart and Diabetes Institute, Central Clinical School, Monash University, Melbourne, Australia
,
Xiao-Ming Gao
1   Baker IDI Heart and Diabetes Institute, Central Clinical School, Monash University, Melbourne, Australia
,
Helen Kiriazis
1   Baker IDI Heart and Diabetes Institute, Central Clinical School, Monash University, Melbourne, Australia
,
Yang Liu
1   Baker IDI Heart and Diabetes Institute, Central Clinical School, Monash University, Melbourne, Australia
,
Abhirup Lobo
1   Baker IDI Heart and Diabetes Institute, Central Clinical School, Monash University, Melbourne, Australia
,
Geoffrey A. Head
1   Baker IDI Heart and Diabetes Institute, Central Clinical School, Monash University, Melbourne, Australia
,
Anthony M. Dart
1   Baker IDI Heart and Diabetes Institute, Central Clinical School, Monash University, Melbourne, Australia
2   Alfred Heart Centre, the Alfred Hospital, Central Clinical School, Monash University, Melbourne, Australia
› Author Affiliations Financial support: This study was funded by grants from the National Health and Medical Research Council (NHMRC) of Australia. XJD, GAH and AMD are NHMRC fellows.
Further Information

Publication History

Received: 16 July 2010

Accepted after major revision: 19 October 2010

Publication Date:
25 November 2017 (online)

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Summary

Left ventricular thrombus (LVT) and rupture are important mechanical complications following myocardial infarction (MI) and are believed to be due to unrelated mechanisms. We studied whether, in fact, wall rupture and LVT are closely related in their pathogenesis with intramural platelet thrombus (IMT) playing a pivotal role. Male 129sv and C57Bl/6 mice underwent operation to induce MI, and autopsy was performed to confirm rupture deaths. Haemodynamic features of rupture events were monitored by telemetry in conscious mice. Detailed histological examination was conducted with special attention to the presence of IMT in relation to rupture location and LVT formation. IMT was detected in infarcted hearts of 129sv (82%) and C57Bl/6 (39%) mice with rupture in the form of a narrow streak spanning the wall or an occupying mass dissecting the infarcted myofibers apart. IMT often contained dense inflammatory cells and blood clot, indicating a dynamic process of thrombus formation and destruction. Notably, IMT was found extending into the cavity to form LVT. Haemodynamic monitoring by telemetry revealed that rupture occurred either as a single event or recurrent episodes. Importantly, the anti-platelet drug clopidogrel, but not aspirin, reduced the prevalence of rupture (10% vs. 45%) and IMT, and suppressed the degree of inflammation. Thus, IMT is a key pathological element in the infarcted heart closely associated with the complications of rupture and LVT. IMT could be either triggered by a wall tear or act as initiator of rupture. IMT may propagate towards the ventricular chamber to trigger LVT.

Keywords

Myocardial infarction - intramural thrombus - left ventricular thrombus - ventricular rupture - platelet - inflammation - anti-platelet drugs - haemodynamics
 

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