Chest
Volume 83, Issue 2, February 1983, Pages 228-232
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Two Dimensional Echocardiography in the Diagnosis of Left Ventricular Thrombus: A Prospective Study of 67 Patients with Anatomic Validation

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Seventy-two patients, in whom a high prevalence of left ventricular thrombus (LVT) was anticipated, were studied prospectively by two-dimensional echocardiography (2DE). Adequate echocardiograms were obtained in 67 patients (93 percent). Presence or absence of LVT was verified at surgery in 51 patients undergoing aneurysmectomy, and at autopsy in 16 patients dying from acute myocardial infarction. Twenty-six patients had LVT and 41 did not. The LVT was defined echocardiographically as an echo-dense mass adjacent to asynergic left ventricular wall and distinct from the endocardial surface. Twenty-four of 26 LVT were correctly predicted by 2DE (sensitivity 92 percent). Absence of LVT was correctly predicted in 36 of 41 patients (specificity 88 percent). In five patients, LVT by 2DE was not anatomically confirmed (17 percent false positives). Thus, 2DE can detect or exclude the presence of LVT with a good sensitivity and specificity.

Section snippets

METHODS

Seventy-two patients were studied by 2DE. Adequate echocardiograms were obtained in 67 patients (93 percent). These patients form the study group. There were 51 men and 16 women. Their mean age was 57 years (range 36 to 81). Fifty-two patients underwent surgery for a cineangiographically-documented aneurysm during a 29-month period, from September 1979 to February 1982.

Indication for surgery was angina in 32 patients (61 percent), dyspnea in nine patients (17 percent), ventricular tachycardia

Echocardiographic Left Ventricular Thrombus

In 29 patients, LVT was identified by 2DE. Figures 1 and 2 shows stop frames of echocardiograms of patients with LVT in acute and chronic infarction. In all but three patients, LVT was located at the cardiac apex; two patients had LVT in a large posterior aneurysm at the base of the heart, and one patient in an anterolateral aneurysm. All apical LVT could be visualized from the apical acoustic window.

Correlation with Surgery and Autopsy

Thrombi were present in 26 patients either at surgery or at autopsy. In 24 (true positives) of

DISCUSSION

In the recent past, the presence of LVT could only be suspected when a patient suffered a clinically recognized systemic embolus. Left ventricular cineangiography has been used to detect LVT; the reported sensitivity, however, is low.13,19-21 In our series, the sensitivity was indeed low (35 percent).

Apart from isolated case reports,22, 23, 24 M-mode echocardiography is not sensitive in the detection of LVT,7 because the large majority are located in the cardiac apex.1,17 This area of the left

ACKNOWLEDGMENTS

We want to thank Marga van Corler and Harry de Koning for their technical assistance and Pia Botman for her help in the preparation of the manuscript.

References (0)

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Manuscript received May 14; revision accepted September 16.

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