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[Ventricular thrombi in the chronic infarct stage]
Insights
Two-dimensional echocardiography detects left ventricular thrombi in 11% of myocardial infarction patients. This imaging technique accurately identifies thrombi, aiding in the prevention of embolic events.
Area of Science:
- Cardiology
- Medical Imaging
Context:
- Left ventricular thrombi (LVT) are a known complication of myocardial infarction (MI).
- Accurate detection of LVT is crucial for risk stratification and management.
- 2-D echocardiography is a primary imaging modality for cardiac assessment.
Purpose:
- To evaluate the diagnostic performance of 2-D echocardiography in detecting left ventricular thrombi in patients with chronic myocardial infarction.
- To determine the sensitivity and specificity of echocardiography compared to intraoperative findings.
- To identify optimal echocardiographic views and characteristics for thrombus visualization.
Summary:
- A study of 864 patients with chronic myocardial infarction found left ventricular thrombi in 11% using 2-D echocardiography.
- The diagnostic accuracy (sensitivity and specificity) reached 90% when compared to intraoperative findings.
- Thrombi were predominantly located in akinetic/dyskinetic segments near the apex, best visualized in apical views. High-frequency transducers are recommended to differentiate thrombi from normal structures.
Impact:
- Echocardiography provides a reliable, non-invasive method for diagnosing LVT post-MI.
- Early detection of LVT can help mitigate the risk of embolic complications.
- Findings guide optimal imaging protocols for LVT detection in clinical practice.
Abstract:
Left ventricular thrombi were detected in 98 (11%) of 864 consecutive patients examined by 2-D-echocardiography in the chronic phase of myocardial infarction. Using unequivocal criteria in identifying intracavitary masses as thrombus, the sensitivity and specificity of the echocardiographic diagnosis reached 90% compared to intraoperative findings (n = 23). To avoid false positive diagnoses, normal apical structures like muscular trabeculae must be ruled out, preferably by applying high-frequency transducers. All thrombi were located on akinetic or dyskinetic segments near the ventricular apex. Accordingly they were best visualised in the apical 4-chamber (92%) and 2-chamber (96%) views as well as in apical short-axis cross-sections (49%). Thrombus size ranged from 0.5 to 32 cm2. Two-thirds of the thrombi appeared as flat, one-third as protruding masses. Thrombi were found mainly with anterior wall infarctions (14.5%) and with aneurysms (28.5%), but rarely with posterior wall infarctions (.6%). 95% of the thrombus patients had suffered large infarctions. The rate of embolic events prior to the thrombus diagnosis was 7% in patients with thrombi but only 0.6% in patients without thrombi.