Key result
Cine-CMR boosts LV thrombus detection sensitivity ~50% vs TTE.
Why the study?
CMR LGE is theoretically highly accurate for thrombus detection, but the comparative diagnostic accuracy of various CMR techniques and transthoracic echocardiography in patients with impaired systolic LV function required evaluation.
Does Cardiac Magnetic Resonance Imaging improve diagnostic sensitivity for left ventricular thrombus detection compared to transthoracic echocardiography in patients with impaired systolic function?
Cohort (n=206)
Single-blind
No
Does Cardiac Magnetic Resonance Imaging improve diagnostic sensitivity for left ventricular thrombus detection compared to transthoracic echocardiography in patients with impaired systolic function?
Absolute Event Rate: 75% vs 50%
p-value: p=0.008
CMR provides significantly higher sensitivity for detecting left ventricular thrombi than standard echocardiography, which is crucial as LGE-CMR detected thrombi are strongly associated with embolic events.
Cine-CMR may enhance LV thrombus detection in reduced EF; leaves open whether adoption improves outcomes in observational cohorts.
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.
No takes yet. Share an insight, caveat, or question.
Chaosuwannakit et al. (2021) conducted a cohort in Impaired systolic left ventricular function (n=206). Cardiac Magnetic Resonance Imaging (CMR) vs. Transthoracic echocardiography (TTE) was evaluated on Sensitivity for left ventricular thrombus identification (p=0.008). Cine-CMR increased the sensitivity for left ventricular thrombus identification to 75% compared to 50% by transthoracic echocardiography (p=0.008).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: