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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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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.
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2021, RadiographyCitation Excerpt :Therefore prompt and accurate detection of LV thrombus to facilitate timely anticoagulation treatment is paramount.1,2 Transthoracic echocardiography is the most widely used screening modality for LV thrombus, particularly in the context of recent myocardial infarction, or to assess the cause for an ischaemic stroke.3,4 However, in patients with limited acoustic windows it can be challenging to identify a small apical LV thrombus and they can be missed.
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2021, Annals of Thoracic SurgeryCitation Excerpt :These results are comparable to the findings of Meurin and coworkers,10 who studied LVT in patients with anterior myocardial infarction; these investigators also found high sensitivity and specificity for LVT detection (94.7% and 98.5%, respectively). A similar investigation demonstrated that prospective TTE detection of LVT in patients undergoing aneurysmectomy showed a similar sensitivity (92%) and a slightly lower specificity (88%).11 Stratton and colleagues12 found TTE to have a sensitivity of 95% and specificity of 86% in a group of patients who underwent 2-dimensional TTE and in whom independent confirmation of the presence or absence of LVT was also available.
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2016, Seminars in Arthritis and RheumatismCitation Excerpt :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].
Manuscript received May 14; revision accepted September 16.