Abstract
Objective: Cardiovascular magnetic resonance imaging (CMR) late gadolinium enhancement technique (LGE) detects thrombus rather than anatomical presence based on tissue properties and is theoretically highly accurate. The present study’s goal was to compare the diagnostic accuracy obtained with various CMR techniques and transthoracic echocardiography to diagnose left ventricular thrombus and evaluate the prevalence and perspectives of left ventricular (LV) thrombus among patients with impaired systolic left ventricular function. Methods: In a single academic referral center, a retrospective database review of all CMR assessments of the established left ventricular thrombus was carried out in 206 consecutive patients with reduced systolic function for five years. To assess thrombus risk factors, clinical and imaging parameters were analyzed. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), echocardiography, and cine-CMR sequence accuracy have been identified. LV structural parameters were quantified to detect markers for thrombus and predictors of the additive usefulness of contrast-enhanced thrombus imaging. Comparisons against LGE-CMR were made, which was used as the standard. Results: A 7.8 percent prevalence of left ventricular thrombus was identified by LGE-CMR. Cine-CMR increased the diagnostic efficiency for echocardiographic thrombus identification in this group, with sensitivity increasing from 50 percent by echocardiography to 75 percent by cine-CMR (p = 0.008). Dark blood CMR (DB-CMR) has better sensitivity and accuracy than echocardiography (p < 0.001), comparable to cine-CMR. The transmural infarct size was an independent marker for thrombus after correction for the LVEF and LV volume while considering only CMR parameters. There were significantly higher embolic events (HR = 71.33; CI 8.31–616.06, p < 0.0001) in LV thrombus patients detected by LGE-CMR. Conclusion: CMR imaging was more sensitive to left ventricular thrombi identification compared with transthoracic echocardiography. An additional parameter available from LGE-CMR and shown as an independent risk factor for left ventricular thrombus is the myocardial scar.
Highlights
There is considerable morbidity and mortality of left ventricular thrombus (LVT), complicating impaired left ventricular systolic function
As a novel noninvasive cardiac imaging method, cardiac magnetic resonance imaging (CMR) has been introduced to complement data collected by echocardiography in patients with various cardiovascular diseases with plenty of other new CMR techniques to enhance sensitivity for LVT detection [10,11,12,13]
Late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) has been reported to characterize viable and infarcted myocardium based on contrast uptake patterns
Summary
There is considerable morbidity and mortality of left ventricular thrombus (LVT), complicating impaired left ventricular systolic function. The standard transthoracic echocardiogram (TTE) is widely used for screening, its sensitivity for detecting LV thrombus is limited The detection of these thrombi with magnetic resonance imaging has a high yield. As a novel noninvasive cardiac imaging method, cardiac magnetic resonance imaging (CMR) has been introduced to complement data collected by echocardiography in patients with various cardiovascular diseases with plenty of other new CMR techniques to enhance sensitivity for LVT detection [10,11,12,13]. The purpose of this study was to evaluate the prevalence of LGE-CMR thrombus in patients with an impaired left ventricular systolic function and to evaluate the diagnostic accuracy achieved with echocardiography and different CMR sequences for the diagnosis of LVT, as well as to evaluate different parameters for the prediction of the risk factor for LVT
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
