Clinical, imaging, and pathological characteristics of left ventricular thrombus: A comparison of contrast-enhanced magnetic resonance imaging, transthoracic echocardiography, and transesophageal echocardiography with surgical or pathological validation

doi:10.1016/j.ahj.2005.08.021

American Heart Journal

Volume 152, Issue 1, July 2006, Pages 75-84

https://doi.org/10.1016/j.ahj.2005.08.021 Get rights and content

Background

Left ventricular (LV) thrombus is a frequent and potentially dangerous complication of ischemic heart disease (IHD). We evaluated the clinical, imaging, and pathology characteristics of confirmed LV thrombus and compared the diagnostic value of contrast-enhanced magnetic resonance imaging (MRI) with transthoracic (TTE) and transesophageal echocardiography (TEE) for the diagnosis of LV thrombi.

Methods

Between November 1997 and December 2003, 361 patients with IHD had surgical and/or pathological confirmation of presence or absence of LV thrombus. Clinical information and preoperative imaging study reports were retrospectively reviewed regarding detection of thrombus. Comparisons were made between clinical and imaging characteristics of patients with and without confirmed thrombus.

Results

Left ventricular thrombus was present in 106 (29%) of 361 patients in this study. Patients with thrombus had a higher incidence of recent embolic events (6.1% vs 0.8%, P < .005). In 160 patients with all 3 imaging modalities performed within 30 days of surgical or pathological confirmation, contrast-enhanced MRI showed the highest sensitivity and specificity (88% ± 9% and 99% ± 2%, respectively) compared with TTE (23% ± 12% and 96% ± 3.6%, respectively) and TEE (40% ± 14% and 96% ± 3.6%, respectively) for thrombus detection.

Conclusions

Left ventricular thrombus occurs frequently in patients with IHD and is associated with risk of systemic embolization. Contrast-enhanced MRI provided the highest sensitivity and specificity for LV thrombus when compared to TTE and TEE, and should be considered in the care of patients at high risk of LV thrombus formation.

Section snippets

Methods

The investigation was approved by the institutional review board of the medical center, and the following methods were applied.

Patient characteristics

Based on surgical and/or pathology assessment of the LV, thrombus was present in 106 (29%) of 361 patients with IHD.

There was no significant difference in clinical characteristics between patients with and without LV thrombus (Table I), except for the incidence of a recent systemic embolic event, which was significantly higher in the group with confirmed thrombus (6.1% vs 0.8%, P < .005). In addition, patients with LV thrombus, as compared to patients with no thrombus, cumulatively had a

Discussion

LV thrombus formation after MI is associated with high risk of systemic embolization.4, 13 Anticoagulant therapy may significantly decrease the incidence of embolic events by 33% compared to untreated patients.4, 14 In addition, up to 40% of embolic events occur when thrombi are neither protuberant nor mobile.¹⁵ Given the morbidity and mortality associated with systemic embolization, and lack of data supporting routine anticoagulation therapy for patients with heart failure,¹⁶ it is important

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Background

Methods

Results

Conclusions

Section snippets

Methods

Patient characteristics

Discussion

J Am Coll Cardiol

Am J Cardiol

Chest

J Am Coll Cardiol

Am Heart J

Chest

J Am Coll Cardiol

J Am Soc Echocardiogr

J Am Soc Echocardiogr

Am J Cardiol

Predischarge two-dimensional echocardiographic evaluation of left ventricular thrombosis after acute myocardial infarction in the GISSI-3 study

Am J Cardiol

Incidence of left ventricular thrombosis after acute transmural myocardial infarction

N Engl J Med

Increased embolic risk in patients with left ventricular thrombi

Circulation

Detection and characterization of intracardiac thrombi on MR imaging

Am J Roentgenol