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Updated: May 20, 2026
Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
Differentiation between fresh and old left ventricular thrombi by deformation imaging
Markus Niemann1, Philipp Daniel Gaudron, Bart Bijnens
1Comprehensive Heart Failure Center, Department of Internal Medicine I, Institute of Radiology, University of Wuerzburg, Oberdürrbacher Strasse 6, Würzburg, Germany.
Insights
Echocardiography can now differentiate fresh from old left ventricular thrombi using strain-rate imaging. Fresh thrombi, identified by specific strain-rate patterns, often resolve with anticoagulation therapy.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Differentiating fresh from old left ventricular thrombi post-myocardial infarction is crucial for assessing embolization risk and guiding anticoagulation therapy.
- Current noninvasive methods lack definitive accuracy in distinguishing thrombus age.
Purpose of the Study:
- To evaluate the efficacy of echocardiographic strain-rate (SR) imaging in differentiating fresh from old left ventricular thrombi.
- To assess the impact of anticoagulation on fresh thrombi identified by SR imaging.
Main Methods:
- A two-part study involving 52 patients with post-myocardial infarction thrombi.
- Substudy-I: 20 patients with known fresh or old thrombi analyzed using SR imaging.
- Substudy-II: 32 patients with incident thrombi treated with phenprocoumon and followed for 6 months, assessed with SR imaging, standard echocardiography, and MRI.
Main Results:
- Peak SR during isovolumetric relaxation period effectively discriminated between fresh (5-27 days) and old (4-26 months) thrombi (cutoff: 1 s(-1)).
- In prospective substudy-II, 17 thrombi classified as fresh showed 94% resolution after 6 months of phenprocoumon.
- Conversely, 14 of 15 old thrombi remained unchanged, with only one resolving.
Conclusions:
- Echocardiographic deformation imaging, specifically peak SR during isovolumetric relaxation, reliably differentiates fresh from old intracavitary thrombi.
- Anticoagulation with phenprocoumon promotes significant resolution of fresh left ventricular thrombi.
Background:
Noninvasive echocardiographic differentiation between old and fresh left ventricular thrombi after myocardial infarction would be of clinical importance to estimate the risk for embolization and the necessity of anticoagulation.
Methods And Results:
Fifty-two patients, aged 41 to 87 years, with a thrombus after myocardial infarction were included in this 2-part study: In substudy-I, 20 patients, 10 each with a definite diagnosis of fresh or old thrombus, were included. In the subsequent prospective substudy-II, 32 consecutive patients with an incident thrombus after myocardial infarction but unknown thrombus age were started on phenprocoumon and followed for 6 months. Data on medical history, standard echocardiography, strain-rate (SR) imaging and magnetic resonance tomography were analyzed. In substudy-I, analysis of thrombus deformation revealed the most rapid change in SR during the isovolumetric relaxation period when cavity pressure decreases rapidly. Fresh (range: 5-27 days) and old thrombi (4-26 months) could be discriminated without overlap by peak SR during the isovolumetric relaxation period, using a cutoff value of 1 s(-1). Applying this threshold value in substudy-II, 17 thrombi were echocardiographically classified as fresh (=SR ≥1 s(-1)) and 15 as old. After 6 months in the fresh thrombus group, 16 of 17 thrombi had disappeared (94%), and in 1 patient the thrombus size was diminished by >50% (now presenting an old thrombus SR pattern). In contrast, 14 of the 15 old thrombi remained unchanged in size and deformation (1 thrombus disappeared).
Conclusions:
Fresh and old intracavitary thrombi can be reliably differentiated by deformation imaging. In fresh thrombi, anticoagulation with phenprocoumon results in thrombus resolution in most patients.
