Advancing clinical management of left ventricular thrombosis: prevention, detection and treatment modalities in the modern era

Area of Science:

• Cardiology
• Thrombosis
• Medical Imaging

Background:

• Left ventricular thrombus (LVT) is linked to stroke and systemic embolism, yet its management remains evidence-limited.
• Understanding LVT pathophysiology and improving diagnostic accuracy are crucial for effective intervention.
• Standard imaging modalities may underestimate LVT, contributing to delayed diagnosis and treatment.

Purpose of the Study:

• To provide a comprehensive educational review of left ventricular thrombus.
• To discuss LVT pathophysiology, diagnostic approaches, and modern treatment strategies.
• To propose a management algorithm and highlight future research needs.

Main Methods:

• Review of current literature on LVT pathophysiology, diagnosis, and treatment.
• Analysis of echocardiographic and multimodality imaging techniques for LVT detection.
• Evaluation of existing guidelines and expert consensus on LVT management.
• Discussion of direct oral anticoagulants (OACs) in the context of LVT.

Main Results:

• LVT is associated with significant embolic risks, underscoring the need for accurate diagnosis.
• Echocardiography and multimodality imaging play key roles in LVT assessment.
• Direct oral anticoagulants (OACs) show promise in LVT management with early safety and efficacy.
• An algorithm for LVT prevention and treatment is proposed based on current evidence.

Conclusions:

• Accurate diagnosis and understanding of LVT pathophysiology are essential for effective patient management.
• Multimodality imaging enhances LVT detection and characterization.
• Direct oral anticoagulants represent a significant advancement in LVT treatment strategies.
• Further research is needed for robust risk stratification in LVT patients.