Key result
Transthoracic echocardiography demonstrated 94.7% sensitivity and 98.5% specificity for detecting left ventricular thrombi compared with CMR-DE in patients with anterior MI and LVEF <45%.
Why the study?
Does transthoracic echocardiography accurately detect left ventricular thrombus compared to cardiac magnetic resonance imaging in patients with anterior myocardial infarction and low LVEF?
Observational (n=100)
Blinded examiners
Yes
Does transthoracic echocardiography accurately detect left ventricular thrombus compared to cardiac magnetic resonance imaging in patients with anterior myocardial infarction and low LVEF?
Effect estimate: Sensitivity 94.7%, Specificity 98.5%
Left ventricular thrombus is a frequent complication after anterior MI with systolic dysfunction, and prespecified TTE has high diagnostic accuracy compared to CMR-DE.
TTE may allow reliable LV thrombus screening post-anterior MI with low LVEF; extends observational data but leaves open need for prospective confirmation.
BACKGROUND AND OBJECTIVES: We aimed to assess the incidence and evolution of left ventricular (LV) thrombi in a high-risk population of patients with LV systolic dysfunction after anterior myocardial infarction (ant-MI). We also compared the accuracy of transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging with contrast-delayed enhancement (CMR-DE) in detecting LV thrombi. METHODS: We prospectively included 100 consecutive patients with LV ejection fraction (LVEF) <45% at the first TTE performed <7 days after ant-MI. A second evaluation with TTE and CMR-DE (by blinded examiners) was performed at 30 days. A third TTE and assessment of clinical status were performed between 6 and 12 months after ant-MI. RESULTS: Patients (males 71%; mean age 59.1 ± 12.1 years; mean LVEF 33.5% ± 6.0%) were included at a median of 5.5 days (interquartile range 25th-75th percentile 4.25-6.0 days) after ant-MI. Thrombi were detected among 26 (26%) patients at a median of 12.0 days after ant-MI (7 patients at 1-7 days after MI; 15 at 8-30 days; and 4 after day 30). Sensitivity and specificity for LV thrombi detection were 94.7% and 98.5%, respectively, for TTE as compared with CMR-DE. Most thrombi (n = 24; 92.3%) disappeared after triple antithrombotic therapy (vitamin K antagonist in addition to dual antiplatelet therapy). CONCLUSION: Left ventricular thrombus is a frequent complication after ant-MI with systolic dysfunction. When a search for thrombus is prespecified, the accuracy of TTE is high as compared with CMR-DE. The best antithrombotic strategy is not known.
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Meurin et al. (2015) conducted an observational in Anterior myocardial infarction with left ventricular systolic dysfunction (n=100). Transthoracic echocardiography (TTE) vs. Cardiac magnetic resonance imaging with contrast-delayed enhancement (CMR-DE) was evaluated on Sensitivity and specificity for LV thrombi detection (Sensitivity 94.7%, Specificity 98.5%). Transthoracic echocardiography demonstrated 94.7% sensitivity and 98.5% specificity for detecting left ventricular thrombi compared with CMR-DE in patients with anterior MI and LVEF <45%.
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