What is the clinical evidence from this study?

Study design: Review. Population: Left heart intracardiac thrombus. Intervention: Cardiac magnetic resonance (CMR) vs. Echocardiography (TTE/TEE) and Computed Tomography (CCT).

What does this research mean for the field?

Cardiac magnetic resonance is emerging as a valuable alternative to echocardiography and computed tomography for detecting and monitoring left heart intracardiac thrombus. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To review the clinical relevance of left atrium, left atrial appendage, and left ventricle thrombi and summarize the diagnostic performance of current modalities and emerging cardiac magnetic resonance techniques.

January 1, 2022Therapeutic Advances in Cardiovascular DiseaseOpen Access

Imaging of left heart intracardiac thrombus: clinical needs, current imaging, and emerging cardiac magnetic resonance techniques

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Key result

CMR outperforms TTE for detecting left heart intracardiac thrombus with superior diagnostic accuracy.

Why the study?

Detecting and monitoring left heart intracardiac thrombus is vital to guide treatment and prevent systemic thromboembolism, prompting growing interest in the value of CMR alongside echocardiography and computed tomography.

Key Points

To review the clinical relevance of left atrium, left atrial appendage, and left ventricle thrombi and summarize the diagnostic performance of current modalities and emerging cardiac magnetic resonance techniques.
Reviewed diagnostic performance literature for transthoracic echocardiography, transesophageal echocardiography, contrast-enhanced cardiac computed tomography, and cardiac magnetic resonance.
Assessed diagnostic modalities across clinical cohorts with atrial fibrillation, risk of cardioembolic stroke, and left ventricular dysfunction.
Transesophageal echocardiography demonstrates sensitivity and specificity as high as 100% and 99% for left atrial appendage thrombus, while three-dimensional transthoracic echocardiography improved appendage detection over two-dimensional imaging (68.1% versus 45.5%).
Contrast-enhanced cardiac computed tomography achieved 100% sensitivity, specificity, positive predictive value, and negative predictive value at a 6-min delayed phase in a cohort where 10 of 260 patients had thrombi.
Cardiac magnetic resonance provides the most accurate detection for left ventricular thrombi, while non-enhanced sequences detected left atrial appendage thrombus sizes consistently ≈20% larger than transesophageal echocardiography.

Structured PICO

Population

A review of studies evaluating the diagnostic performance of imaging modalities, particularly cardiac magnetic resonance, for detecting left atrial, left atrial appendage, and left ventricular thrombus.

Intervention

Imaging modalities including echocardiography, computed tomography, and emerging cardiac magnetic resonance (CMR) techniques

Outcome

Diagnostic performance for detecting and monitoring left heart intracardiac thrombus

This review highlights the clinical importance of detecting left heart intracardiac thrombus and evaluates the diagnostic performance of echocardiography, CT, and emerging CMR techniques.

Limitations

Long acquisition time
Breath-holding requirements which can be difficult for severely ill patients
Cost and limited availability
Renal dysfunction limiting the use of contrast agents
Requirement for technical expertise

Implication

May support CMR when echocardiography is inconclusive for left heart thrombus; leaves open prospective validation before practice change.

Abstract

Intracardiac thrombus in the left atrium and atrial appendage (LA/LAA) and left ventricle (LV) increases the risk of systemic thromboembolism and causes potentially devastating diseases such as ischemic stroke and acute ischemia in abdominal organs and lower extremities. Detecting the presence and monitoring the resolution of left heart intracardiac thrombus are of vital importance for stratifying patients and guiding treatment decisions. Currently, echocardiography is the most frequently used method for the above clinical needs, followed by computed tomography. An increasing number of studies have been performed to investigate the value of cardiac magnetic resonance (CMR) as an alternative imaging modality given its several unique strengths. This article provides an overview of the clinical relevance of the LA/LAA and LV thrombus as well as the diagnostic performance of the current imaging modalities and emerging CMR techniques.

Discussion

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Figures from the paper

Published by Therapeutic Advances in Cardiovascular Disease · CC BY-NC

Cite This Study

Chang et al. (2022) conducted a review in Left heart intracardiac thrombus. Cardiac magnetic resonance (CMR) vs. Echocardiography (TTE/TEE) and Computed Tomography (CCT) was evaluated. Cardiac magnetic resonance is a highly accurate, non-invasive modality for detecting left heart intracardiac thrombus, offering superior diagnostic performance compared to transthoracic echocardiography.

synapsesocial.com/papers/6a1d5f367328fa9a742f660f https://doi.org/10.1177/17539447221107737

Topics

Left atrial appendage closure

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Implication

May support CMR when echocardiography is inconclusive for left heart thrombus; leaves open prospective validation before practice change.

Imaging of left heart intracardiac thrombus: clinical needs, current imaging, and emerging cardiac magnetic resonance techniques

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Topics

Imaging of left heart intracardiac thrombus: clinical needs, current imaging, and emerging cardiac magnetic resonance techniques

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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