Key result
Contrast echocardiography detected a left ventricular apex thrombus in an 80-year-old post-myocardial infarction patient despite an unremarkable standard echocardiogram.
Why the study?
Does contrast echocardiography improve the detection of apical thrombus compared to standard echocardiography in post-myocardial infarction patients?
Case Report (n=1)
Does contrast echocardiography improve the detection of apical thrombus compared to standard echocardiography in post-myocardial infarction patients?
Contrast echocardiography may be superior to standard echocardiography for detecting apical thrombi in high-risk post-MI patients, suggesting a potential role for routine screening.
May support selective contrast use post-MI; hypothesis-generating case report leaves routine adoption open.
A a 80-year-old male underwent routine transthoracic echocardiography the day after primary percutaneous revascularization procedure for ST-elevation myocardial infarction. When ultrasound contrast was injected, regular contrast-enhancement of the left ventricle (LV) excluded the presence of thrombus. A second echocardiogram, performed four months later, showed a hyperechoic image in the LV apex, which was confirmed after contrast injection as a thrombus. Four weeks later, a third follow-up echocardiogram appears apparently normal. However, contrast injection clearly demonstrates a new apex thrombus, in a slightly different location from the one detected previously. Standard echocardiography is often inconclusive or falsely negative regarding the detection of apical thrombus. Maybe the time has come for routine contrast-echo screening in post-myocardial infarction patients with the high likelihood of thrombus, such as in cases of apical infarction, even if the standard echocardiogram appears unremarkable.
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Siniscalchi et al. (2021) conducted a case report in ST-elevation myocardial infarction (n=1). Contrast echocardiography vs. Standard echocardiography was evaluated on Detection of apical thrombus. Contrast echocardiography detected a left ventricular apex thrombus in an 80-year-old post-myocardial infarction patient despite an unremarkable standard echocardiogram.
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