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Article

Left Ventricular Thrombi: Insights from Cardiac Magnetic Resonance Imaging

1
Radiology Department, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
2
Cardiology Unit, Internal Medicine Department, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
*
Author to whom correspondence should be addressed.
Academic Editors: Markus Barth and Brian D. Ross
Tomography 2021, 7(2), 180-188; https://doi.org/10.3390/tomography7020016
Received: 19 March 2021 / Revised: 21 April 2021 / Accepted: 4 May 2021 / Published: 12 May 2021
Objective: Cardiovascular magnetic resonance imaging (CMR) late gadolinium enhancement technique (LGE) detects thrombus rather than anatomical presence based on tissue properties and is theoretically highly accurate. The present study’s goal was to compare the diagnostic accuracy obtained with various CMR techniques and transthoracic echocardiography to diagnose left ventricular thrombus and evaluate the prevalence and perspectives of left ventricular (LV) thrombus among patients with impaired systolic left ventricular function. Methods: In a single academic referral center, a retrospective database review of all CMR assessments of the established left ventricular thrombus was carried out in 206 consecutive patients with reduced systolic function for five years. To assess thrombus risk factors, clinical and imaging parameters were analyzed. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), echocardiography, and cine-CMR sequence accuracy have been identified. LV structural parameters were quantified to detect markers for thrombus and predictors of the additive usefulness of contrast-enhanced thrombus imaging. Comparisons against LGE-CMR were made, which was used as the standard. Results: A 7.8 percent prevalence of left ventricular thrombus was identified by LGE-CMR. Cine-CMR increased the diagnostic efficiency for echocardiographic thrombus identification in this group, with sensitivity increasing from 50 percent by echocardiography to 75 percent by cine-CMR (p = 0.008). Dark blood CMR (DB-CMR) has better sensitivity and accuracy than echocardiography (p < 0.001), comparable to cine-CMR. The transmural infarct size was an independent marker for thrombus after correction for the LVEF and LV volume while considering only CMR parameters. There were significantly higher embolic events (HR = 71.33; CI 8.31–616.06, p < 0.0001) in LV thrombus patients detected by LGE-CMR. Conclusion: CMR imaging was more sensitive to left ventricular thrombi identification compared with transthoracic echocardiography. An additional parameter available from LGE-CMR and shown as an independent risk factor for left ventricular thrombus is the myocardial scar. View Full-Text
Keywords: cardiac MRI; left ventricular thrombi; late gadolinium enhancement cardiac MRI; left ventricular thrombi; late gadolinium enhancement
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MDPI and ACS Style

Chaosuwannakit, N.; Makarawate, P. Left Ventricular Thrombi: Insights from Cardiac Magnetic Resonance Imaging. Tomography 2021, 7, 180-188. https://doi.org/10.3390/tomography7020016

AMA Style

Chaosuwannakit N, Makarawate P. Left Ventricular Thrombi: Insights from Cardiac Magnetic Resonance Imaging. Tomography. 2021; 7(2):180-188. https://doi.org/10.3390/tomography7020016

Chicago/Turabian Style

Chaosuwannakit, Narumol; Makarawate, Pattarapong. 2021. "Left Ventricular Thrombi: Insights from Cardiac Magnetic Resonance Imaging" Tomography 7, no. 2: 180-188. https://doi.org/10.3390/tomography7020016

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