Comparative value of invasive and noninvasive techniques for identifying left ventricular mural thrombi

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    TTE can also detect complex and irregular masses adherent to the endocardial surface of any cardiac chamber or great vessels, and TEE can provide details about their anatomy and pathophysiology [12,21,24,25]. For the detection of left ventricular thrombi, TTE has a sensitivity and a specificity of 86–95% [26–28]. TTE can not reliably visualize the left atrium or left atrial appendage (LAA), and has a sensitivity of only 39–63% for the detection of left atrial thrombi [29–31].

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    The larger studies indicate a risk of stroke between 1% and 3% forall infarctions, and between 2% and 6% for patients experiencinganterior MIs. In the prethrombolysis era, echocardiographic studies showed that LVthrombus rarely occurs with inferior AMI2, 6 but developsin up to 40% of patients with anterior MIs,4, 6, 7, 8 particularly when there is apical akinesis ordyskinesis.5, 6, 7, 9 Additional risk factors includeextensive infarction, a dilated and dysfunctional LV, acute aneurysm, congestive heart failure (CHF), and atrial fibrillation.

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Supported in part by National Institutes of Health New Investigator Research Award No. 1 R23 HL 27508-01, and by the Veterans Administration.

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