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Updated: Jun 9, 2025

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

10.2K

Evolution of left ventricular thrombus on serial cardiovascular magnetic resonance imaging

Parag Bawaskar1, Abel A Hooker Mendez1, Pal Satyajit Singh Athwal1

  • 1Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA.

European Heart Journal. Cardiovascular Imaging
|October 22, 2024
PubMed

Insights

Left ventricular (LV) thrombus resolution is slower than previously thought, with significant embolic risk persisting beyond six months, especially in patients with unresolved thrombus. Extended anticoagulation is recommended.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Thrombosis Research

Background:

  • Current management of left ventricular (LV) thrombus lacks robust data, relying on older echocardiography studies.
  • Embolic risk and thrombus evolution patterns are poorly understood.
  • Cardiovascular magnetic resonance imaging (CMR) is the gold standard for LV thrombus detection.

Purpose of the Study:

  • To investigate the evolution of left ventricular (LV) thrombus using serial cardiovascular magnetic resonance imaging (CMR).
  • To identify factors associated with the lack of thrombus resolution.
  • To assess the embolic risk related to LV thrombus resolution status.

Main Methods:

  • Retrospective cohort study of 107 patients with LV thrombus.
  • Serial CMR scans performed at a median of 255 days post-diagnosis.
  • Survival analysis using landmark methods to evaluate embolic events.

Main Results:

  • A significant proportion of LV thrombi remained unresolved at 3, 6, and 12 months post-CMR detection (75%, 53%, and 37%, respectively).
  • Factors associated with no resolution included myocardial infarction history, LV aneurysm, ischemic cardiomyopathy, and larger thrombus volume.
  • Embolic events were more frequent beyond 6 months, particularly in patients with unresolved LV thrombus.

Conclusions:

  • LV thrombus resolution rates are lower than previously reported, with substantial embolic risk persisting beyond 6 months.
  • Unresolved LV thrombus on serial CMR is linked to increased embolic risk.
  • Extended anticoagulation is warranted for patients with markers of poor LV thrombus resolution.
Abstract

Keywords:
cardiovascular magnetic resonanceleft ventricular thrombusnatural historyrecurrenceresolutionserial imaging

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