Role of Imaging for Suspected Cardiac Thrombus

Whalen, Hallie; Dako, Farouk; Patel, Pratik; Sahbaz, Jasmin; Hong-Zohlman, Susie; White, Charles S.; Jeudy, Jean

doi:10.1007/s11936-019-0792-6

Cited by 6 publications

(10 citation statements)

References 58 publications

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“…At present, the most commonly used method for diagnosing cardiac thrombi is TTE which often focuses on their size, number, shape, mobility, and location [ 8 , 9 ]. To our knowledge, we lack the means to judge the hardness which is related to stability of cardiac thrombi at present.…”

Section: Introductionmentioning

confidence: 99%

Cardiac thrombotic stability determined by contrast-enhanced echocardiography: investigative protocol and preliminary results

Wang

Ren

et al. 2021

BMC Cardiovasc Disord

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Objective This study’s intent was to test a new system for scoring cardiac thrombotic stability, based on contrast-enhanced ultrasound (CEUS). Methods We used human whole blood for an in vitro thrombotic model involving 1-h (T1h) and 7-day (T7d) subsets. The T1h group was monitored for 1 h continuously to observe for the formation of a new thrombus on the original thrombus base. Changes in thrombotic CEUS images, histologic features, and shear wave elastography were recorded over time. We also studied 28 patients diagnosed with cardiac thrombi, each examined by transthoracic echocardiography and CEUS.Thrombi were scored for substrate (Ts) and hardness (Th) based on the visualized degree of contrast penetration into the thrombi. Statistical analyses of Ts and Th reflected thrombolytic time and risk of embolism to other organs. Results Histologically, the loosely constructed ends of in vitro thrombi solidified over time. In addition, the average Young’s modulus of thrombi over time indicated a progressive increase in hardness. Contrast-enhancing agents were able to penetrate fresh, loose thrombi only, not chronic, stable thrombi. As Ts and Th increased, prolonged thrombolytic time and greater risk of embolism to other organs were apparent. Conclusions Our data suggest that this new CEUS scoring system correlates well with cardiac thrombotic hardness and the quality of its underlying substrate, serving to quantify thrombotic stability.

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Section: Introductionmentioning

confidence: 99%

Cardiac thrombotic stability determined by contrast-enhanced echocardiography: investigative protocol and preliminary results

Wang

Ren

et al. 2021

BMC Cardiovasc Disord

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“…Accurate decision-making in the evaluation of cardiac thrombi stability is critical to guide therapy and procedure planning [1]. TTE is widely accepted as a primary screening tool in the evaluation of cardiac thrombus because it is noninvasive, convenient, and has a high specificity and sensitivity [9]. However, there are many limitations [10].…”

Section: Discussionmentioning

confidence: 99%

“…At present, the most commonly used method for diagnosing cardiac thrombus is TTE which often focus on their size, number, shape, activity, and location [8,9]. To our knowledge, we lack the means to judge the hardness which is related to stability of cardiac thrombus at present.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Cardiac Thrombus Stability based on Contrast-Enhanced Echocardiography：Research Protocol and Preliminary Results

Liu¹,

Wang²,

Ren³

et al. 2021

Preprint

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Objective: This study attempted to test a new scoring system for evaluating the stability of cardiac thrombi using contrast-enhanced ultrasound (CEUS). Methods: We used human whole blood to make the thrombus model in vitro which were divided into 2 groups, the 1-hour (T1h) and 7-day (T7d) group. The T1h group was monitored for 1 hour continuously to observe for the formation of a new thrombus on the original thrombus base. Over time, changes in CEUS images and pathology and shear wave elastography (SWE) of thrombus were observed in theT1h and T7 groups. Twenty-eight adult patients diagnosed with a cardiac thrombus were selected and examined by transthoracic echocardiography (TTE) and CEUS. Thrombi were scored for substrate (Ts) and hardness (Th) based on the visualized degree of contrast penetration into the thrombus. The Ts and Th were statistically analyzed for thrombolytic time and the risk of embolism to other organs. Results: In vitro, pathology revealed a decreased pore structure; further, the average Young’s modulus of the thrombi over time indicated a progressive increase in hardness. Contrast-enhancing agents were able to enter a fresh, loose thrombus, but were not able to enter a chronic, stable thrombus. With increasing Ts and Th, thrombolytic time was prolonged, and the risk of embolism to other organs was increased. Conclusions: Our study results suggest that this new CEUS scoring system can evaluate the hardness of a cardiac thrombus and the quality of its underlying substrate; this allows for quantitative evaluation of thrombus stability.

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“…The LV thrombus is not uncommonly found in patients with ischaemic cardiomyopathy. 1 However, multiple sites of LV thrombi with RA appendage thrombus in ischaemic cardiomyopathy with sinus rhythm are rare. [2][3][4] The Virchow's triad, which consists of blood stasis, endothelial injury and hypercoagulable state, could explain the intracardiac thrombus formation like other vascular thrombi.…”

Section: Descriptionmentioning

confidence: 99%

“…[2][3][4] The CMR is considered as the gold standard modality to detect an intracardiac thrombus with the highest sensitivity, specificity, positive predictive value and negative predictive value. 1 An intracardiac thrombus can cause an embolic event leading to catastrophic morbidity and mortality. Early detection with prompt initiation of anticoagulant is the key management to prevent disability and improve survival.…”

Section: Descriptionmentioning

confidence: 99%

Multiple, extensive intracardiac thrombi in patient with ischaemic cardiomyopathy

et al. 2021

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Role of Imaging for Suspected Cardiac Thrombus

Cited by 6 publications

References 58 publications

Cardiac thrombotic stability determined by contrast-enhanced echocardiography: investigative protocol and preliminary results

Cardiac thrombotic stability determined by contrast-enhanced echocardiography: investigative protocol and preliminary results

Evaluation of Cardiac Thrombus Stability based on Contrast-Enhanced Echocardiography：Research Protocol and Preliminary Results

Multiple, extensive intracardiac thrombi in patient with ischaemic cardiomyopathy

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