Objectives
To evaluate performance characteristics of routine echo for LV thrombus (LVT).
Background
While the utility of dedicated echocardiography (echo) for LVT is established, echo is widely used as a general test for which LVT is rarely the primary indication. We used delayed enhancement cardiac magnetic resonance (DE-CMR) as a reference to evaluate LVT detection by routine echo.
Methods
Dedicated LVT assessment using DE-CMR was prospectively performed in patients with LV systolic dysfunction. Echoes were done as part of routine clinical care. Echo and CMR were independently read for LVT and related indices of LVT size, shape, and image quality/diagnostic confidence. Follow-up was done for embolic events and pathology validation of LVT.
Results
243 patients had routine clinical echo and dedicated CMR within 1 week without intervening events. Follow-up supported DE-CMR as a reference standard, with >5-fold difference in endpoints between patients with vs. without LVT by DE-CMR (p=0.02). LVT prevalence was 10% by DE-CMR. Echo contrast was used in 4% of patients. Echo sensitivity and specificity were 33% and 91%, with positive and negative predictive values of 29% and 93%. Among patients with possible LVT as the clinical indication for echo, sensitivity and positive predictive value were markedly higher (60%, 75%). Regarding sensitivity, echo performance related to LVT morphology and mirrored cine-CMR, with protuberant thrombus typically missed when small (p≤0.02). There was also a strong trend to miss mural thrombus irrespective of size (p=0.06). Concerning positive predictive value, echo performance related to image quality, with lower diagnostic confidence scores for echoes read positive for LVT in discordance with DE-CMR compared to echoes concordant with DE-CMR (p<0.02).
Conclusions
Routine echo with rare contrast use can yield misleading results concerning LVT. Echo performance is improved when large protuberant thrombus is present and when the clinical indication is specifically for LVT assessment.
OBJECTIVES This study introduced and validated a novel flow-independent delayed enhancement technique that shows hyperenhanced myocardium while simultaneously suppressing blood-pool signal.BACKGROUND The diagnosis and assessment of myocardial infarction (MI) is crucial in determining clinical manage-
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