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Published on: June 11, 2019
Left ventricular thrombus routine screening with contrast echocardiography in patients with anterior ST-elevation
Joana Laranjeira Correia1, Gonçalo R M Ferreira2, João Gouveia Fiuza2
1Cardiology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal. joanalaranjeira11166@gmail.com.
Insights
Contrast transthoracic echocardiography (TTE) showed a trend toward improved left ventricular thrombus detection in anterior ST-elevation myocardial infarction (STEMI) patients. Further research is needed to confirm its effectiveness in routine diagnosis.
Area of Science:
- Cardiology
- Medical Imaging
- Clinical Trials
Background:
- Left ventricular (LV) thrombus is more common in anterior ST-elevation myocardial infarction (STEMI) and linked to poorer outcomes.
- Accurate diagnosis of LV thrombus is challenging, impacting antithrombotic/anticoagulation strategies.
- Contrast echocardiography, specifically transthoracic echocardiography (TTE), shows promise for enhancing diagnostic accuracy.
Purpose of the Study:
- To evaluate the efficacy of contrast TTE as a routine screening tool for detecting LV thrombus during the acute phase of anterior STEMI.
- To compare thrombus detection rates between patients undergoing contrast TTE and those receiving conventional TTE.
Main Methods:
- A prospective, single-center, randomized controlled trial was performed.
- Patients with anterior STEMI were randomized into a study group (contrast TTE) and a control group (conventional TTE).
- Demographic, clinical, and diagnostic data were collected, and thrombus detection rates were compared.
Main Results:
- A total of 68 patients were analyzed (32 in the study group, 36 in the control group).
- The thrombus detection rate was 25.0% with contrast TTE versus 13.9% with conventional TTE (P=0.24), not reaching statistical significance.
- Anterior/apical aneurysm prevalence was significantly higher in the contrast TTE group (46.9% vs. 22.2%, P=0.03).
Conclusions:
- Conventional TTE may suffice for LV thrombus diagnosis in acute anterior STEMI.
- Larger, multicenter studies are required for definitive conclusions on contrast TTE's role.
- Ultrasound contrast may be valuable for identifying anterior/apical aneurysms, risk factors for thrombus formation.
Background:
Left ventricular (LV) thrombus has a higher incidence among patients with anterior ST-elevation myocardial infarction (STEMI) when compared to other types of acute myocardial infarction and is associated with worse prognosis. The management of LV thrombus diagnosis remains challenging. Contrast echocardiography (transthoracic echocardiography, TTE) has shown potential in improving the accuracy for its diagnosis, thereby influencing treatment strategies concerning antithrombotic/anticoagulation therapy. The aim of this study was to assess the effectiveness of contrast TTE as a routine screening method for detecting LV thrombus in the acute phase of anterior STEMI.
Methods:
A prospective, single center, randomized controlled trial was conducted among patients with anterior STEMI. The study group underwent contrast TTE, while the control group received a conventional approach. Demographical, clinical, and diagnostic data were collected. Thrombus detection rates were compared between groups.
Results:
A total of 68 patients were included (32 in the study group and 36 in the control group). No substantial baseline differences were observed between groups. Thrombus detection rate was 25.0% in the study group and 13.9% in the control group, however these results did not reach statistical significance (P = 0.24). The prevalence of anterior/apical aneurysm was higher in the study group (46.9% vs. 22.2%, P = 0.03).
Conclusions:
Conventional TTE may be adequate for diagnosing LV thrombus in the acute phase of anterior STEMI; however, further larger-scale and multicenter studies are necessary to obtain more robust and conclusive results. Ultrasound contrast may play a significant role in the detection of anterior/apical aneurysms, which are known risk factors for the subsequent development of thrombus.
Trial Registration:
NCT06480929 (ClinicalTrials.gov, Retrospectively registered).
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