Prognostic usefulness of left ventricular thrombus by echocardiography in dilated cardiomyopathy in predicting stroke, transient ischemic attack, and death

Abstract Background Left ventricular thrombus (LVT) formation represents a common complication of dilated cardiomyopathy (DCM). LVT is usually underestimated with transthoracic echocardiography (TTE) while cardiac magnetic resonance imaging (CMRI) is promising as an alternative imaging modality for cardiac thrombus detection. The study aims to compare TTE and CMRI in their ability to detect LVT, also, to assess the clinical and imaging parameters to determine variables that may predispose for thrombus formation. The study population includes seventy-six patients with ischemic DCM. They were divided into 2 groups based on the presence of LVT as detected by delayed-enhancement CMRI (DE-CMRI) [Group A included 20 patients with a LVT and Group B included 56 patients without]. Results All of the current study population had ischemic DCM with left ventricular ejection fraction (LVEF) < 50%. DE-CMR detected thrombus in 20 cases of the studied population that represented group A. From group A, conventional TTE detected LVT only in 8 and cine-CMR detected 13 cases out of the out of 20 cases. The ejection fraction of the left ventricle as measured by functional CMRI was significantly lower in group A (P = 0.045). Interestingly, the myocardial scarring in group A was seen significantly more extensive than in group B (the P value is < 0.00001), paralleling the increased prevalence of thrombus. Conclusions DE-CMRI provides superiority for the detection of LVT compared with standard TTE or cine-CMRI and the amount of myocardial scarring detected by DE-CMRI can be considered an independent marker for thrombus presence.

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Arterial thromboembolism in a young woman with occult dilated cardiomyopathy

Case Reports in Internal Medicine ◽

10.5430/crim.v3n3p12 ◽

2016 ◽

Vol 3 (3) ◽

pp. 12

Author(s):

Alicia Topoll ◽

Jordan Owens ◽

Jorge Cheirif ◽

J. Mark Pool ◽

Mark Feldman

Keyword(s):

Heart Failure ◽

Dilated Cardiomyopathy ◽

Systolic Heart Failure ◽

Left Ventricular ◽

Left Ventricular Thrombus ◽

Caucasian Woman ◽

Prothrombotic State ◽

Vascular Intervention ◽

Arterial Thromboembolism ◽

Ventricular Thrombus

An acute dilated cardiomyopathy may present with vague symptoms including fatigue and malaise, which may delay the diagnosis until signs and symptoms of systolic heart failure develop. Left ventricular thrombus and arterial thromboembolism are rare complications of acute dilated cardiomyopathy. We present a case of a young Caucasian woman presenting with acute leg ischemia secondary to femoral artery thromboembolism associated with a previously undiagnosed acute dilated cardiomyopathy with severe systolic heart failure and a large left ventricular thrombus. Her prothrombotic state was refractory to heparin therapy and surgical vascular intervention. She eventually required leg amputation for recurrent limb ischemia with gangrene and thrombus extraction from the left ventricle. Risk factors for her prothrombotic state included the acute, dilated cardiomyopathy, use of a hormonal contraceptive agent, obesity, smoking, and a heterozygous Factor II (Prothrombin) G20110A mutation.

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