Prognostic Relevance of Left Ventricular Thrombus Motility: Assessment by Pulsed Wave Tissue Doppler Imaging

Abstract

Pulsed wave tissue Doppler imaging (PW-TDI) easily detects motion of cardiac structures. Hence, PW-TDI could be of value for assessing potentially cardioembolic masses. We sought to evaluate the prognostic value of left ventricular (LV) thrombus mobility assessed by PW-TDI. In 83 consecutive patients with echocardiographically detected LV thrombi, PW-TDI echocardiographic study was performed. At 1-year follow-up, the composite of major adverse cardiovascular events (MACE) defined as all-cause mortality plus hospitalizations for stroke/systemic embolism was evaluated. Seventy-two patients (77.1 ± 13.1 year/old, 32 males) were studied. All thrombi were located at the LV apex. At 1-year follow-up, 17 cardioembolic events occurred. By univariable Cox analysis, variables associated with MACE were heart rate (hazard ratio: 1.02, 95% CI: 1.00-1.05; P = .03), thrombi with mobile free edge (hazard ratio: 3.25, 95% CI: 1.25-8.44; P = .01), hypoechoic thrombi (hazard ratio: 2.86, 95% CI: 1.10-7.42; P = .03), and mass peak antegrade velocity (Va) ≥10 cm/s (hazard ratio: 8.79, 95% CI: 2.00-38.5; P = .004). By multivariable analysis, thrombi with mobile free edge (hazard ratio: 3.54, 95% CI: 1.23-10.2; P = .02), and mass peak Va ≥10 cm/s (hazard ratio: 7.97, 95% CI: 1.60-39.6; P = .01) retained statistical significance. Mass peak Va ≥10 cm/s predicted the composite end point with 94% sensitivity and 85% specificity (area under the curve = 0.86). In conclusion, PW-TDI allows objective prognostication of LV thrombi embolic risk.

Retrospective Analysis of Left Ventricular Thrombus Among Heart Failure Patients with Reduced Ejection Fraction at a Single Tertiary Care Hospital in Somalia

“…The article's limitations include a small sample size, a retrospective single experience center, and technical deficiencies in echocardiography, such as the measurement of thrombus mass mobility by pulse wave Doppler, which is a prognostic indicator for hospitalized patients. 27,28 Overall, these results cannot be generalized to the entire population due to these limitations. The epidemiological findings of LVT in heart failure at the continental and national levels should be supported by larger-scale studies in the future.…”

Takotsubo syndrome and atrial myxoma—identifying a new trigger: a case report

“…Those masses with a higher instantaneous velocity are associated with a greater outward force, which would increase the probability of the mass being ejected into the bloodstream. Thus, a mass peak antegrade velocity (Va) ≥ 10 cm/s has been proposed as a marker of embolization, allowing identification of patients at risk and timely decision making ( 19 ).…”

Incidental Finding of Lipomatous Hypertrophy of the Right Atrial Free Wall in an Elderly Female With Severe Pulmonary Hypertension: Early Detection by Multimodality Imaging

“…It is important to consider LAH in the differential diagnosis of echocardiographic intracavitary RA masses. Different from endocardial vegetations, tumors, and thrombi, which have a pattern of incoherent motion, characterized by velocity and direction of movement independent and completely different from the surrounding myocardial and valve tissues, and without any correlation with the cardiac cycle [ 1 - 3 ]. In our case, the suspected RA mass observed during the TTE examination had a concordant motion with the anterior RA free wall and the antero-lateral tricuspid annulus and was in synchrony with the phases of the cardiac cycle.…”