Cardiac thrombus in dilated cardiomyopathy. Relationship between left ventricular pathophysiology and left ventricular thrombus.

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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Dilated Cardiomyopathy Complicated by a Pedunculated and Mobile Left Ventricular Thrombus on Ruptured False Tendons

CHEST Journal ◽

10.1378/chest.99.4.1042 ◽

1991 ◽

Vol 99 (4) ◽

pp. 1042-1043 ◽

Cited By ~ 4

Author(s):

Shigehiko Mukai ◽

Hideo Fuseno ◽

Mitsuo Nakamura ◽

Junichi Yoshikawa ◽

Toyo Shomura

Keyword(s):

Dilated Cardiomyopathy ◽

Left Ventricular ◽

Left Ventricular Thrombus ◽

Ventricular Thrombus

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Frequency and embolic potential of left ventricular thrombus in dilated cardiomyopathy: Assessment by 2-dimensional echocardiography

The American Journal of Cardiology ◽

10.1016/0002-9149(83)90588-x ◽

1983 ◽

Vol 52 (10) ◽

pp. 1281-1285 ◽

Cited By ~ 135

Author(s):

John S. Gottdiener ◽

Judith A. Gay ◽

Lucy VanVoorhees ◽

Robert DiBianco ◽

Ross D. Fletcher

Keyword(s):

Dilated Cardiomyopathy ◽

Left Ventricular ◽

Left Ventricular Thrombus ◽

Ventricular Thrombus ◽

Dimensional Echocardiography

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The prevalence of left ventricular thrombus among patients with low ejection fraction by trans-thoracic echocardiography

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.4.1972 ◽

2020 ◽

Vol 36 (4) ◽

Author(s):

Nouradden Noman Aljaber ◽

Zohoor Ali Mattash ◽

Sultan Abdulwadoud Alshoabi ◽

Fahad Hassan Alhazmi

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Heart Disease ◽

Ejection Fraction ◽

Dilated Cardiomyopathy ◽

Left Ventricular ◽

Left Ventricular Thrombus ◽

Ventricular Thrombus ◽

The Mean ◽

Low Ejection Fraction

Background and objectives: Ejection fraction (EF) is a measurement of heart function that reflects the portion of pumped out blood from the filled left ventricle per each heartbeat. The current study aimed to investigate the prevalence of left ventricular thrombus in patients with EF lower than 35% by using Transthoracic Echocardiography (TTE). Methods: In this prospective study, 82 cardiac patients underwent TTE procedure in order to assess the presence of left ventricular thrombus (LVT) from January 1st to December 31st 2017 at the Military Cardiac Centre in Sana’a, Yemen. Results: Out of 82 patients enrolled in this study, the mean age was 49.13 ± 14.8 years and 87.8% were male. The mean of EF was 31.16% and LVT was found in 6.1%. The spontaneous contrast was seen in 25.6% of patients indicating strong relationship with low EF (p < 0.001). Among patients with low EF, ischemic heart disease (IHD) was identified in 50%, hypertension in 30.5%, diabetes mellitus (DM) type 2 in 23.2%, and hyperlipidemia 12.2%. Exactly 80% of LVT were detected in IHD patients with dilated cardiomyopathy (DCMP) and 80% of detected LVT were apical in site. Conclusion: Cardiac patients with low ejection fraction developed left ventricular thrombosis, and most of the affected patients were ischemic heart disease with dilated cardiomyopathy. Interestingly, spontaneous contrast was found high significantly in these patients, which may reflect the continuous process of thrombus formation. Abbreviations:EF: ejection fraction, ASE: American society of echocardiography, EACVI: European association of cardiovascular imaging, LV: left ventricle, LVEF: left ventricular ejection fraction, HFpEF: heart failure with preserved ejection fraction, HFrEF: heart failure with reduced ejection fraction, MI: myocardial infarction, DCMP: dilated cardiomyopathy, AF: atrial fibrillation, TTE: Transthoracic echocardiography, TEE: trans-esophageal echocardiography, RHD: rheumatic heart disease, HTN: hypertension, DM: diabetes mellitus, CHF: congestive heart failure, JVP: jugular venous pressure, CBC: complete blood count, LFT: liver function tests, RFT: renal function test, LVT: left ventricular thrombus, ECG: electrocardiography, LVT: left ventricular thrombus, EDV: end diastolic volume, ESV: end systolic volume, SPSS: statistical package for the social sciences, IBM: international business machines, SD: standard deviation. doi: https://doi.org/10.12669/pjms.36.4.1972 How to cite this:Aljaber NN, Mattash ZA, Alshoabi SA, Alhazmi FA. The prevalence of left ventricular thrombus among patients with low ejection fraction by trans-thoracic echocardiography. Pak J Med Sci. 2020;36(4):---------. doi: https://doi.org/10.12669/pjms.36.4.1972 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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