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Comparative recognition of left ventricular thrombi by echocardiography and cineangiography
Insights
Cross sectional echocardiography offers superior accuracy in detecting left ventricular mural thrombi compared to cineangiography. This imaging technique is more reliable for identifying thrombi, aiding in patient diagnosis and treatment decisions.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Left ventricular mural thrombi can complicate various cardiac conditions.
- Accurate detection is crucial for appropriate patient management and therapeutic strategies.
Purpose of the Study:
- To compare the diagnostic accuracy of cross-sectional echocardiography and cineangiography in detecting left ventricular mural thrombi.
- To evaluate the impact of anticoagulation treatment on the incidence of mural thrombi.
Main Methods:
- Retrospective review of 47 patients (11 aneurysmectomy, 36 cardiac transplantation).
- Independent analysis of cross-sectional echocardiography (37 patients) and cineangiography (26 patients) by experienced observers blinded to outcomes.
- Pathological confirmation of mural thrombus.
Main Results:
- Mural thrombus confirmed in 14 of 47 patients (30%); 11 were intra-aneurysmal.
- Cross-sectional echocardiography demonstrated a superior positive predictive value compared to cineangiography.
- Mural thrombi were less frequent in patients on anticoagulation (3/20) versus those not (10/19).
Conclusions:
- Cross-sectional echocardiography is a more reliable imaging modality for recognizing left ventricular mural thrombi than cineangiography.
- The findings support the use of cross-sectional echocardiography for improved diagnostic yield in patients at risk for mural thrombi.
Abstract:
Studies performed in 47 patients, 11 of whom underwent surgery for aneurysmectomy and 36 of whom underwent cardiac transplantation, were reviewed to assess the diagnostic accuracies of cross sectional echocardiography and cineangiography in detecting left ventricular mural thrombi and the effect of anticoagulation treatment on the incidence of such thrombi. Cross sectional echocardiography in 37 patients and cineangiography in 26 (16 patients were examined by both methods) were analysed independently by sets of two observers experienced in the respective methods. All four observers were blinded to the pathological or surgical findings regarding mural thrombus. Mural thrombus was confirmed by pathological investigation in 14 of 47 (30%) cases; 11 of these 14 patients had intra-aneurysmal thrombi. The negative predictive value was quite good for both methods, but cross sectional echocardiography had a superior positive predictive value. This was due both to detailed soft tissue resolution by cross sectional echocardiography and to overdetection of mural thrombi by cineangiography in cases of aneurysms without mural thrombi. Mural thrombi were present in three of 20 patients with preceding anticoagulation and in 10 of 19 patients without anticoagulation. The results emphasise that cross sectional echocardiography is more reliable than cineangiography in recognising thrombi.