1126-114 Clinical and magnetic resonance imaging characteristics of pathologically confirmed left ventricular thrombus in patients with cardiomyopathy

Objective: Cardiovascular magnetic resonance imaging (CMR) late gadolinium enhancement technique (LGE) detects thrombus rather than anatomical presence based on tissue properties and is theoretically highly accurate. The present study’s goal was to compare the diagnostic accuracy obtained with various CMR techniques and transthoracic echocardiography to diagnose left ventricular thrombus and evaluate the prevalence and perspectives of left ventricular (LV) thrombus among patients with impaired systolic left ventricular function. Methods: In a single academic referral center, a retrospective database review of all CMR assessments of the established left ventricular thrombus was carried out in 206 consecutive patients with reduced systolic function for five years. To assess thrombus risk factors, clinical and imaging parameters were analyzed. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), echocardiography, and cine-CMR sequence accuracy have been identified. LV structural parameters were quantified to detect markers for thrombus and predictors of the additive usefulness of contrast-enhanced thrombus imaging. Comparisons against LGE-CMR were made, which was used as the standard. Results: A 7.8 percent prevalence of left ventricular thrombus was identified by LGE-CMR. Cine-CMR increased the diagnostic efficiency for echocardiographic thrombus identification in this group, with sensitivity increasing from 50 percent by echocardiography to 75 percent by cine-CMR (p = 0.008). Dark blood CMR (DB-CMR) has better sensitivity and accuracy than echocardiography (p < 0.001), comparable to cine-CMR. The transmural infarct size was an independent marker for thrombus after correction for the LVEF and LV volume while considering only CMR parameters. There were significantly higher embolic events (HR = 71.33; CI 8.31–616.06, p < 0.0001) in LV thrombus patients detected by LGE-CMR. Conclusion: CMR imaging was more sensitive to left ventricular thrombi identification compared with transthoracic echocardiography. An additional parameter available from LGE-CMR and shown as an independent risk factor for left ventricular thrombus is the myocardial scar.

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Echocardiography vs Cardiac Magnetic Resonance Imaging for the Diagnosis of Left Ventricular Thrombus: A Systematic Review

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2015.01.011 ◽

2015 ◽

Vol 31 (6) ◽

pp. 785-791 ◽

Cited By ~ 28

Author(s):

Idan Roifman ◽

Kim A. Connelly ◽

Graham A. Wright ◽

Harindra C. Wijeysundera

Keyword(s):

Magnetic Resonance Imaging ◽

Systematic Review ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Cardiac Magnetic Resonance Imaging ◽

Left Ventricular ◽

Left Ventricular Thrombus ◽

Resonance Imaging ◽

Ventricular Thrombus

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Abstract 1975: Detection Of Left Ventricular Thrombus With Cardiac Magnetic Resonance Imaging In Patients With Acute St-segment Elevation Myocardial Infarction (stemi)

Circulation ◽

10.1161/circ.116.suppl_16.ii_426-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Ingo Eitel ◽

Kathrin Schindler ◽

Josef Friedenberger ◽

Georg Fuernau ◽

Gerhard Schuler ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Myocardial Infarction ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Cardiac Magnetic Resonance Imaging ◽

Late Enhancement ◽

Left Ventricular ◽

Resonance Imaging ◽

Ventricular Thrombus ◽

Left Ventricular Thrombi

Introduction Previously published studies showed differences regarding the prevalence of intraventricular thrombi in patients with acute myocardial infarction (MI) (4–56%). Until now there are no exact results about the occurrence of left ventricular thrombi in acute STEMI. Recognition of LV thrombus is important because the related risk of systemic embolization is high. Methods To investigate the extent of myocardial infarction we examined 225 consecutive patients undergoing primary percutaneous coronar intervention (PCI) in acute STEMI within 12 h after symptom onset by cardiac magnetic resonance imaging within 2– 4 days. Routinely all patients were examined with transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE). All images were analyzed for the presence of intraventricular thrombi. Results In 18 patients (8.0%) we detected left ventricular thrombi, but none of these were seen in TTE or TEE. In two cases an intraventricular thrombus was detected by TEE and TTE, but in the subsequently performed MRI no thrombus was found. In all cases the left ventricular thrombi could be detected in the late enhancement sequence, 8 (44.4%) of them were missed in the cine SSFP sequences. Left ventricular thrombi were more frequently diagnosed in patients with moderate to severe impairment of the left ventricular systolic function (13/18 [72,2%]). Remarkable was also that 14 (77.8%) of the 18 patients with left ventricular thrombus in MRI had an anterior MI, whereas only 2 (11.1%) had an inferior MI, 1 (5,6%) a septal MI and 1 patient (5,6%) a lateral MI. Conclusion In our study TEE and TTE missed left ventricular thrombi in all 18 patients as compared to MRI. There were two false-positive results in TEE and TTE as compared to MRI. Patients with impaired left ventricular function and acute anterior MI have a higher risk of developing left ventricular thrombi than in other infarct-locations. Therefore it could be potentially important to screen in particular high-risk patients (with anterior MI and impaired left ventricular function) with cardiac magnetic resonance imaging to exclude left ventricular thrombi and to lower the risk of embolic events. In particular late enhancement sequences are suitable to detect intraventricular thrombi.

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