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Flow characteristics in the dilated left ventricle with thrombus: qualitative and quantitative Doppler analysis

S S Maze1, M N Kotler, W R Parry

  • 1Department of Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania 19141.

Journal of the American College of Cardiology
|March 15, 1989
PubMed

Insights

Abnormal blood flow patterns in the left ventricle are linked to mural thrombus formation. This study found significantly lower inflow and systolic velocities at the apex in patients with left ventricular thrombus.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Fluid Dynamics

Background:

  • Mural thrombus in the left ventricle is a serious complication, particularly in patients with cardiomyopathy.
  • Understanding the relationship between cardiac blood flow and thrombus formation is crucial for risk stratification and treatment.

Purpose of the Study:

  • To investigate the association between specific left ventricular (LV) blood flow patterns and the presence of mural thrombus.
  • To quantitatively and qualitatively assess flow characteristics in patients with and without LV thrombus.

Main Methods:

  • Conventional pulsed and two-dimensional Doppler color flow imaging were used to examine 40 patients with cardiomyopathy (20 with LV thrombus, 20 without).
  • Quantitative analysis of flow velocity profiles in the ventricular inflow and outflow compartments was performed using pulsed wave Doppler sampling.
  • Patient groups were matched for age, gender, ventricular dysfunction origin, size, and ejection fraction.

Main Results:

  • Patients with LV thrombus exhibited significantly lower inflow velocity at the ventricular apex compared to those without (11.7 vs. 28.3 cm/s, p < 0.0001).
  • Lower flow velocities were observed throughout the inflow compartment in the thrombus group, including the mitral annulus, leaflet tips, and papillary muscle levels.
  • Systolic flow velocity at the apex was also significantly lower in the thrombus group (7.1 vs. 15.3 cm/s, p < 0.001).
  • A higher prevalence of mitral regurgitation was found in the no-thrombus group (14 patients) compared to the thrombus group (3 patients).

Conclusions:

  • Specific abnormal blood flow profiles are associated with the presence of left ventricular mural thrombus.
  • The study suggests a link between altered hemodynamics and thrombus formation, although causality cannot be determined.

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