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Updated: May 28, 2025
Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
Identifying Risk Factors for Left Ventricular Thrombus in Patients with Ischemic Left Ventricular Aneurysm Using
Yanfang Wu1, Hui Wang2, Zhiyan Wang1
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
Left ventricular (LV) aneurysms with wider necks, higher shape indices, and extensive late gadolinium enhancement (>50%) predict thrombus formation. These findings aid in assessing embolic risk in ischemic LV aneurysm patients.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Medical Research
Background:
- Ischemic left ventricular (LV) aneurysm is linked to LV thrombus and embolic events.
- Current guidelines lack evidence-based recommendations for anticoagulation in these patients.
Purpose of the Study:
- To identify characteristics of LV aneurysms associated with a high risk of thrombus formation.
- To inform risk stratification and potential therapeutic strategies for patients with ischemic LV aneurysm.
Main Methods:
- Retrospective study of 317 hospitalized patients with ischemic LV aneurysm undergoing cardiac magnetic resonance (CMR).
- Comparison of baseline characteristics and CMR parameters between patients with and without LV thrombus.
- Logistic regression analysis to identify significant predictors of LV thrombus.
Main Results:
- 88 (27.8%) patients had LV thrombus, associated with heart failure and reduced ejection fraction.
- Significant predictors of LV thrombus included wider aneurysm neck width (OR 1.33), higher shape index (OR 1.63), and LGE global extent >50% (OR 6.58).
- Patients with LV thrombus showed greater LV volume, mass, and LGE extent.
Conclusions:
- Wider aneurysm neck, higher aneurysm shape index, and extensive LGE (>50%) are key predictors of LV thrombus in ischemic LV aneurysm.
- These imaging markers can help identify patients at higher risk for embolic events.
- Further research is warranted to establish anticoagulation guidelines for this patient group.
Abstract:
Ischemic left ventricular (LV) aneurysm is associated with LV thrombus and subsequent embolic events. However, there is currently no evidence-based recommendation for anticoagulation in these patients.To determine the characteristics of LV aneurysms associated with a high risk of thrombus formation.This retrospective study included all hospitalized patients with ischemic LV aneurysm who underwent cardiac magnetic resonance (CMR) from September 2015 to June 2023. Baseline characteristics and CMR parameters were compared between patients with and without LV thrombus. Factors associated with LV thrombus were identified using univariable and multivariable logistic regression analyses.Among the 317 patients included in this study, 88 (27.8%) had LV thrombus. Patients with LV thrombus demonstrated a higher prevalence of heart failure, lower left ventricular ejection fraction, and greater volume, mass, and global extent of late gadolinium enhancement (LGE). They also exhibited distinct LV aneurysm characteristics, such as a larger maximum transverse dimension (maximum width), a wider aneurysm neck, and a higher aneurysm shape index (ratio of maximum length to neck width). Multivariable logistic regression analyses identified aneurysm neck width (OR 1.33 per 5 mm, 95% CI 1.00-1.77, P = 0.047), shape index (OR 1.63 per 20%, 95% CI 1.23-2.16, P = 0.001), and LGE global extent of >50% (OR 6.58, 95% CI 3.04-14.27, P < 0.001) as significant predictors of LV thrombus.A wider aneurysm neck, a higher aneurysm shape index, and LGE global extent >50% are associated with LV thrombus in patients with ischemic LV aneurysm.
