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Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
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Left ventricular thrombus in ischaemic heart disease: diagnosis, treatment, and gaps of knowledge

Ludovic Allard1, Benedikt Bernhard1, Stephan Windecker1

  • 1Department of Cardiology, University Hospital of Bern, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.

European Heart Journal. Quality of Care & Clinical Outcomes
|December 20, 2021
PubMed

Insights

Left ventricular thrombus in ischemic heart disease requires accurate diagnosis and tailored anticoagulation. This review details diagnostic tools, risk stratification, and proposes an updated management algorithm to improve patient outcomes.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Clinical Medicine

Background:

  • Left ventricular thrombus (LVT) is a significant complication in patients with ischemic heart disease (IHD) and myocardial infarction (MI).
  • Despite advances in IHD management, LVT continues to pose substantial risks.
  • Current diagnostic methods like echocardiography have limitations in accuracy.

Purpose of the Study:

  • To review contemporary diagnostic modalities for detecting LVT in IHD.
  • To summarize evidence regarding risk stratification and therapeutic strategies for LVT.
  • To propose a novel algorithm for diagnosis, follow-up imaging, and treatment of LVT.

Main Methods:

  • Review of current literature on diagnostic imaging for LVT.
  • Analysis of evidence on risk stratification and anticoagulation therapy.
  • Development of a proposed diagnostic and therapeutic algorithm.

Main Results:

  • Echocardiography is standard, but cardiac magnetic resonance (CMR) offers higher accuracy.
  • Cardiac computed tomography angiography (CCTA) is a valuable alternative imaging modality.
  • Optimal anticoagulation requires balancing LVT risks with bleeding risks.

Conclusions:

  • Accurate diagnosis and risk-stratified therapy are crucial for managing LVT in IHD.
  • The proposed algorithm aims to guide diagnosis, imaging follow-up, and treatment decisions.
  • Identifying knowledge gaps will inform future research to optimize LVT patient care.

Keywords:
Cardiac computed tomography angiographyCardiac magnetic resonanceDirect oral anticoagulantEchocardiographyEmbolismLeft ventricular thrombusNon-vitamin K antagonist oral anticoagulant (NOAC)StrokeVitamin K antagonist (VKA)

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