Two Dimensional Echocardiography in the Diagnosis of Left Ventricular Thrombus

Visser, Cees A.; Kan, Gerard; David, George K.; Lie, Kong I.; Durrer, D

doi:10.1378/chest.83.2.228

Cited by 141 publications

(45 citation statements)

References 27 publications

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“…Previous studies have shown that standard echocardiography has a sensitivity of 92-95% and a specificity approaching 95% for detecting LV thrombus. 14,15 However, because if the thrombi are small or laminated mural thrombi, it can be difficult to differentiate them from the underlying myocardium. In addition, fresh thrombus may be echolucent and can be missed without a thorough echocardiographic examination.…”

Section: Discussionmentioning

confidence: 99%

Peak C-Reactive Protein Concentration Correlates With Left Ventricular Thrombus Formation Diagnosed by Contrast Echocardiographic Left Ventricular Opacification in Patients With a First Anterior Acute Myocardial Infarction

Seo

Maeda

Ishizu

et al. 2006

Circ J

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eft ventricular (LV) thrombus formation is a complication of acute myocardial infarction (AMI) and it is more prevalent in patients with an anterior AMI, because of the extensive area of severe apical wall motion abnormality with stagnant flow. [1][2][3] Before the era of early revascularization (ie, intravenous thrombolysis or primary coronary intervention), LV thrombus developed in 39% of patients with a first anterior AMI. 4 Although recent studies report that the prevalence has decreased because of early revascularization, 5-9 LV thrombus formation is still a risk of arterial embolism in patients with anterior wall AMI. 6,10 Apical contraction abnormalities with stagnant flow are important factors related to LV thrombus formation, but that alone is not sufficient to identify high-risk patients. Therefore, identification of additional risk factors may be useful. Recently, LV diastolic dysfunction and inflammatory reactions have been reported as associated with LV thrombus formation, 11-13 although reliable predictors have not yet been determined.LV thrombus can be diagnosed with transthoracic echocardiography, 14,15 although on occasion, either the vague nature of the thrombus or technical limitations in the examination renders confirmation difficult. 16 Contrast echocardiography is a useful modality for detecting LV thrombus, because the LV opacification can improve endocardial border delineation in the LV apex. [17][18][19][20] In addition, contrast echocardiography can visualize intraventricular flow dynamics, and recently our group reported that it is possible to determine the presence of stagnant flow with this technique. 21 However, systematic and prospective studies of contrast echocardiographic diagnosis of LV thrombus in patients with first anterior AMI have not been performed. Therefore, the purpose of this study was to prospectively study the determinants of LV thrombus using contrast echocardiography in patients with their first anterior AMI. Methods Study PopulationThis Background Wall motion abnormality in the apical legion of the left ventricle (LV) with stagnant flow alone is not sufficient to identify patients at high risk for LV thrombus formation among those with first anterior acute myocardial infarction (AMI). The aim of this study was to identify the determinants of LV thrombus formation using contrast echocardiography. Methods and ResultsIn 75 patients with first anterior AMI, standard and contrast echocardiography was performed to detect LV thrombus. Although LV thrombus was found in 10 patients (13%) using standard echocardiography, it was found in 15 patients (20%) using contrast echocardiography. Apical stagnant flow was observed in 14 patients (93%) with LV thrombus. In addition, patients with LV thrombus had a higher peak C-reactive protein (CRP) concentration (18.2±4.3 vs 7.9±5.5 mg/dl, p<0.0001). In multivariate analysis, only peak CRP concentration was identified as an independent predictor of LV thrombus (p=0.02, odds ratio: 1.400, confidence interval: 1.040-1.884). The receiv...

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Section: Discussionmentioning

confidence: 99%

Peak C-Reactive Protein Concentration Correlates With Left Ventricular Thrombus Formation Diagnosed by Contrast Echocardiographic Left Ventricular Opacification in Patients With a First Anterior Acute Myocardial Infarction

Seo

Maeda

Ishizu

et al. 2006

Circ J

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“…1,4 In clinical practice LV thrombi are diagnosed by transthoracic echocardiography (TTE). 5 Recent studies with contrastenhanced (CE)-MRI have shown promising results in defining presence and extent of myocardial necrosis and scarring. 6 -8 Because injection of paramagnetic contrast material also enhances the ventricular blood pool, the purpose of the present study was to evaluate the role of CE-MRI in detecting ventricular thrombi in patients with ischemic heart disease.…”

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confidence: 99%

Visualization of Ventricular Thrombi With Contrast-Enhanced Magnetic Resonance Imaging in Patients With Ischemic Heart Disease

et al. 2002

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Background-Ventricular thrombus formation is a frequent and potentially dangerous complication in patients with ischemic heart disease. Although transthoracic echocardiography (TTE) is generally used as diagnostic technique, we explored the role of contrast-enhanced (CE)-MRI to detect ventricular thrombi. Methods and Results-In 57 patients with acute myocardial infarction, chronic myocardial infarction, or ischemic cardiomyopathy, MRI was performed to evaluate ventricular function (CINE-MRI) and to depict presence of myocardial necrosis and/or scarring and no-reflow areas (CE-MRI). All studies were analyzed for concomitant ventricular thrombi. CE-MRI depicted 12 mural thrombi (3.1Ϯ2.9 cm 3 ), located in left ventricular (LV) apex or adherent to anteroseptum, presenting as black, well-defined structures surrounded by bright contrast-enhanced blood. Thrombus formation on CE-MRI was related to larger end-diastolic volumes; lower ejection fractions; the region of delayed enhancement and lowest wall motion score, especially in left anterior descending coronary artery territory; and LV aneurysm formation. On CINE-MRI, thrombi were found in 6 patients. Nonvisualized thrombi were usually small (mean size 1.2Ϯ0.7 cm 3 ). TTE depicted thrombi in 5. Nonvisualized lesions were most frequently located in LV apex and had a larger size than nonvisualized lesions on CINE-MRI (3.0Ϯ3.2 cm 3 ). In 3 patients with suspected apical thrombus on TTE, MRI was normal. Conclusions-CE-MRI is not only an excellent technique to depict myocardial necrosis and scar tissue in patients withischemic heart disease, but this study also suggests a better identification of LV thrombi than with presently used clinical imaging modalities, such as TTE.

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“…While several imaging techniques have been used for its detection (18)(19)(20)(21)(22)(23)(24)(25), two-dimensional echocardiography has been shown to be a sensitive (92%), specific (88%), practical and noninvasive bedside tool (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) to detect and delineate thrombosis in adults and children with cardiomyopathies (7-9). Diagnostic features described in adults (27), which have been applied and confirmed in children (8), include location of the thrombus most frequently in the ventricular apex, the presence of distinct margins with an acoustic density different from the underlying myocardium, free motion of the intracavitary margin of the thrombus, variation in thrombus characteristics noted on serial examinations and abnormal wall motion of the associated myocardial wall segment.…”

Section: Discussionmentioning

confidence: 99%

Presentation, management and outcomes of thrombosis for children with cardiomyopathy

McCrindle

Karamlou

Wong

et al. 2006

Canadian Journal of Cardiology

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Two Dimensional Echocardiography in the Diagnosis of Left Ventricular Thrombus

Cited by 141 publications

References 27 publications

Peak C-Reactive Protein Concentration Correlates With Left Ventricular Thrombus Formation Diagnosed by Contrast Echocardiographic Left Ventricular Opacification in Patients With a First Anterior Acute Myocardial Infarction

Peak C-Reactive Protein Concentration Correlates With Left Ventricular Thrombus Formation Diagnosed by Contrast Echocardiographic Left Ventricular Opacification in Patients With a First Anterior Acute Myocardial Infarction

Visualization of Ventricular Thrombi With Contrast-Enhanced Magnetic Resonance Imaging in Patients With Ischemic Heart Disease

Presentation, management and outcomes of thrombosis for children with cardiomyopathy

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