Meta-analysis of imaging techniques for the diagnosis of left ventricular thrombus following acute myocardial infarction

Left ventricular thrombus (LVT) can occur in patients after acute myocardial infarction (AMI) and carries significant embolic risk. Leveraging imaging tools that can guide the early and accurate diagnosis of LVT and appropriate use of anti-thrombotic therapy can mitigate the risk of embolic events. This study aims to evaluate the utility of common imaging modalities for the diagnosis of LVT in post-AMI patients. Several databases (Medline, Embase and Cochrane Library) were searched until May 2025 for studies reporting on the comparative diagnostic performance of imaging modalities for LVT in post-AMI patients. Fourteen studies were identified for inclusion. Compared to delayed enhancement cardiac magnetic resonance imaging (DE-CMRI), transthoracic echocardiography (TTE) with or without contrast and cine-CMRI all had high specificity and contrast TTE had the highest sensitivity for LVT detection. A strategy to identify high-risk patients who would benefit from further imaging with CMRI to identify LVT should be considered for patients whose TTE is inconclusive. Graphical Abstract Graphical abstract of the study, detailing the study background, methods and key findings. This graphic was created in https://BioRender.com. Abbreviations: LVT – left ventricular thrombus; AMI – acute myocardial infarction; DE-CMRI – delayed enhancement-cardiac magnetic resonance imaging; TTE – transthoracic echocardiography.