Abstract
ObjectiveThis study’s intent was to test a new system for scoring cardiac thrombotic stability, based on contrast-enhanced ultrasound (CEUS).MethodsWe 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.ResultsHistologically, 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.ConclusionsOur 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.
Highlights
Cardiac thrombi formation is a frequent complication in a variety of prevalent diseases [1, 2], carrying a potential for significant morbidity and mortality from cerebrovascular and peripheral vascular events [3]
It has been demonstrated the introduction of a contrast agent during Transthoracic echocardiography (TTE) improves image quality and display the blood supply of the tissue by observing the microbubbles of contrast medium moving with the red blood cells [12, 13]
Study participants An in vitro model of thrombosis was established using 10.0-mL volumes of whole venous blood collected from healthy volunteers (n = 10), each drawn into a 20-mL syringe for water bath incubation at 37 °C (10 syringes in total) [18].The samples were stratified as 1-h (T1h) and 7-day (T7d) subsets (n = 5 each) and analyzed using standard two-dimensional (2-D) classical TTE, contrastenhanced ultrasound (CEUS), and Shear wave elastography (SWE)
Summary
Cardiac thrombi formation is a frequent complication in a variety of prevalent diseases [1, 2], carrying a potential for significant morbidity and mortality from cerebrovascular and peripheral vascular events [3]. Many scholars have begun to study risk factors for thrombotic seeding. The TTE image quality is suboptimal in few patients, which leads to relatively low accuracy and reproducibility [10, 11]. It has been demonstrated the introduction of a contrast agent during TTE improves image quality and display the blood supply of the tissue by observing the microbubbles of contrast medium moving with the red blood cells [12, 13]. There are only a few studies on the application of CEUS in the diagnosis of cardiac thrombosis. According to the previous study, unlike solid tumors, no contrast agent can enter the thrombi without blood supply during CEUS [11, 14, 15]
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