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Contrast-enhanced anatomic imaging as compared to contrast-enhanced tissue characterization for detection of left ventricular thrombus.

Publication ,  Journal Article
Weinsaft, JW; Kim, RJ; Ross, M; Krauser, D; Manoushagian, S; LaBounty, TM; Cham, MD; Min, JK; Healy, K; Wang, Y; Parker, M; Roman, MJ; Devereux, RB
Published in: JACC Cardiovasc Imaging
August 2009

OBJECTIVES: This study sought to compare contrast-enhanced anatomic imaging and contrast-enhanced tissue characterization (delayed-enhancement cardiac magnetic resonance [DE-CMR]) for left ventricular (LV) thrombus detection. BACKGROUND: Contrast echocardiography (echo) detects LV thrombus based on anatomic appearance, whereas DE-CMR imaging detects thrombus based on tissue characteristics. Although DE-CMR has been validated as an accurate technique for thrombus, its utility compared with contrast echo is unknown. METHODS: Multimodality imaging was performed in 121 patients at high risk for thrombus due to myocardial infarction or heart failure. Imaging included 3 anatomic imaging techniques for thrombus detection (contrast echo, noncontrast echo, cine-CMR) and a reference of DE-CMR tissue characterization. LV structural parameters were quantified to identify markers for thrombus and predictors of additive utility of contrast-enhanced thrombus imaging. RESULTS: Twenty-four patients had thrombus by DE-CMR. Patients with thrombus had larger infarcts (by DE-CMR), more aneurysms, and lower LV ejection fraction (by CMR and echo) than those without thrombus. Contrast echo nearly doubled sensitivity (61% vs. 33%, p < 0.05) and yielded improved accuracy (92% vs. 82%, p < 0.01) versus noncontrast echo. Patients who derived incremental diagnostic utility from DE-CMR had lower LV ejection fraction versus those in whom noncontrast echo alone accurately assessed thrombus (35 +/- 9% vs. 42 +/- 14%, p < 0.01), with a similar trend for patients who derived incremental benefit from contrast echo (p = 0.08). Contrast echo and cine-CMR closely agreed on the diagnosis of thrombus (kappa = 0.79, p < 0.001). Thrombus prevalence was lower by contrast echo than DE-CMR (p < 0.05). Thrombus detected by DE-CMR but not by contrast echo was more likely to be mural in shape or, when apical, small in volume (p < 0.05). CONCLUSIONS: Echo contrast in high-risk patients markedly improves detection of LV thrombus, but does not detect a substantial number of thrombi identified by DE-CMR tissue characterization. Thrombi detected by DE-CMR but not by contrast echo are typically mural in shape or small in volume.

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Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

August 2009

Volume

2

Issue

8

Start / End Page

969 / 979

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Thrombosis
  • Stroke Volume
  • Sensitivity and Specificity
  • Registries
  • Prospective Studies
  • Predictive Value of Tests
  • Observer Variation
  • Myocardial Infarction
  • Middle Aged
 

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Weinsaft, J. W., Kim, R. J., Ross, M., Krauser, D., Manoushagian, S., LaBounty, T. M., … Devereux, R. B. (2009). Contrast-enhanced anatomic imaging as compared to contrast-enhanced tissue characterization for detection of left ventricular thrombus. JACC Cardiovasc Imaging, 2(8), 969–979. https://doi.org/10.1016/j.jcmg.2009.03.017
Weinsaft, Jonathan W., Raymond J. Kim, Michael Ross, Daniel Krauser, Shant Manoushagian, Troy M. LaBounty, Matthew D. Cham, et al. “Contrast-enhanced anatomic imaging as compared to contrast-enhanced tissue characterization for detection of left ventricular thrombus.JACC Cardiovasc Imaging 2, no. 8 (August 2009): 969–79. https://doi.org/10.1016/j.jcmg.2009.03.017.
Weinsaft JW, Kim RJ, Ross M, Krauser D, Manoushagian S, LaBounty TM, et al. Contrast-enhanced anatomic imaging as compared to contrast-enhanced tissue characterization for detection of left ventricular thrombus. JACC Cardiovasc Imaging. 2009 Aug;2(8):969–79.
Weinsaft, Jonathan W., et al. “Contrast-enhanced anatomic imaging as compared to contrast-enhanced tissue characterization for detection of left ventricular thrombus.JACC Cardiovasc Imaging, vol. 2, no. 8, Aug. 2009, pp. 969–79. Pubmed, doi:10.1016/j.jcmg.2009.03.017.
Weinsaft JW, Kim RJ, Ross M, Krauser D, Manoushagian S, LaBounty TM, Cham MD, Min JK, Healy K, Wang Y, Parker M, Roman MJ, Devereux RB. Contrast-enhanced anatomic imaging as compared to contrast-enhanced tissue characterization for detection of left ventricular thrombus. JACC Cardiovasc Imaging. 2009 Aug;2(8):969–979.
Journal cover image

Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

August 2009

Volume

2

Issue

8

Start / End Page

969 / 979

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Thrombosis
  • Stroke Volume
  • Sensitivity and Specificity
  • Registries
  • Prospective Studies
  • Predictive Value of Tests
  • Observer Variation
  • Myocardial Infarction
  • Middle Aged