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Updated: Jun 29, 2025
Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
Incidence of left ventricular thrombus following STEMI in the modern era via multimodality imaging: A systematic
Ethan Sacoransky1, Danny Yu Jia Ke1, Prasham Dave1,2
1School of Medicine, Queen's University, Kingston, ON, Canada.
Insights
Left ventricular thrombus (LVT) incidence in ST-elevation myocardial infarction (STEMI) remains significant despite modern treatments. Multimodality imaging confirms LVT is an ongoing issue requiring further investigation.
Area of Science:
- Cardiology
- Medical Imaging
- Public Health
Background:
- Left ventricular thrombus (LVT) is a serious complication of ST-elevation myocardial infarction (STEMI).
- Previous research predates current percutaneous reperfusion strategies.
- Expert opinion suggests a decreased incidence in the modern era.
Purpose of the Study:
- To systematically review and meta-analyze the incidence and diagnosis of LVT in STEMI patients.
- To assess LVT in patients treated with timely percutaneous coronary intervention (PCI).
- To evaluate LVT using multimodality imaging.
Main Methods:
- Systematic review and meta-analysis of 31 studies from the last 10 years.
- Inclusion of studies using contemporary PCI techniques.
- Primary outcome: LVT detection via echocardiogram (with or without contrast) or Cardiac MRI (cMRI).
Main Results:
- Overall STEMI LVT incidence was 5.6% (14,172 patients).
- Anterior STEMI LVT incidence was 12.7% (7382 patients).
- Non-contrast echocardiography sensitivity for LVT was 58.2% vs. cMRI, with 97.8% specificity.
Conclusions:
- LVT incidence in STEMI patients receiving contemporary PCI is consistent with historical data and remains significant.
- LVT is an ongoing clinical issue warranting further research.
- Cardiac MRI and contrast echocardiography detected more LVT than non-contrast echocardiography.
Background:
Left ventricular thrombus (LVT) is a significant complication in STEMI. Previous studies were conducted prior to modern timely percutaneous reperfusion networks. Current expert opinion suggests incidence in the current era has decreased. We conducted a systematic review and meta-analysis to better understand the incidence and diagnosis of LVT in patients with STEMI treated with timely percutaneous techniques as assessed by multimodality imaging.
Methods:
Cochrane, EMBASE, LILACS, and MEDLINE were searched over the last 10 years only including studies using contemporary techniques. The primary outcome was detection of LVT in patients via echocardiogram with or without contrast or Cardiac MRI (cMRI) following STEMI (both anterior and any territory) treated with PCI. Data was pooled across studies and statistical analysis was conducted via random effects model.
Results:
31 studies were included. 18 studies included data on any territory STEMI, totaling 14,172 patients, and an incidence of 5.6% [95% CI 4.3-7.0]. 18 studies were included in analysis for anterior STEMI, totaling 7382 patients and incidence of 12.7% [95% CI 9.8-15.6]. Relative to cMRI as a gold standard, the sensitivity of non-contrast echocardiography to detect LVT was 58.2% [95% CI 46.6-69.2] with a specificity of 97.8% [95% CI 96.3-98.8].
Conclusions:
Incidence of LVT in STEMI patients treated with contemporary timely percutaneous revascularization is in keeping with historical data and remains significant, suggesting this remains an ongoing issue for further investigation. Numerically, both cMRI and contrast echo detected more LVT compared to non-contrast echo in any-territory STEMI patients.
