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Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
06:29

Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques

Published on: June 11, 2019

Left ventricular thrombus formation after acute myocardial infarction as assessed by cardiovascular magnetic

Ronak Delewi1, Robin Nijveldt, Alexander Hirsch

  • 1Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

European Journal of Radiology
|September 22, 2012
PubMed

Insights

Left ventricular (LV) thrombus occurs in significant myocardial infarction (MI) patients post-percutaneous coronary intervention (PCI). Cardiovascular magnetic resonance imaging (CMR) is more accurate than transthoracic echocardiography (TTE) for LV thrombus detection.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Interventional Cardiology

Background:

  • Left ventricular (LV) thrombus is a serious complication following myocardial infarction (MI).
  • Primary percutaneous coronary intervention (PCI) is the standard treatment for ST-elevation MI.
  • The diagnostic accuracy of imaging modalities for LV thrombus requires ongoing evaluation.

Purpose of the Study:

  • To determine the prevalence of LV thrombus in patients with ST-elevation MI treated with primary PCI.
  • To compare the diagnostic accuracy of transthoracic echocardiography (TTE) and cardiovascular magnetic resonance imaging (CMR) for LV thrombus detection.
  • To assess the natural course of LV thrombi in the modern era of primary PCI.

Main Methods:

  • 200 patients with primary PCI underwent baseline and 4-month follow-up TTE and CMR.
  • Two blinded examiners analyzed all imaging studies.
  • Patients were monitored for clinical status and adverse events at 1, 4, 12, and 24 months.

Main Results:

  • Cardiovascular magnetic resonance imaging (CMR) detected LV thrombus in 8.8% of patients at baseline.
  • LV thrombus resolved in most patients, but 2 had persistent thrombi.
  • Routine TTE demonstrated low sensitivity (21-24%) but high specificity (95-98%) compared to CMR, with significant interobserver variability.

Conclusions:

  • Left ventricular (LV) thrombus remains a relevant complication in patients treated for MI with PCI, particularly with larger infarct sizes.
  • Cardiovascular magnetic resonance imaging (CMR) offers superior diagnostic accuracy and lower interobserver variability for LV thrombus detection compared to transthoracic echocardiography (TTE).
  • Transthoracic echocardiography (TTE) exhibits limited sensitivity for detecting LV thrombi, necessitating consideration of advanced imaging modalities.
Abstract

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