Comparison of two-dimensional echocardiography, radionuclide ventriculography and cineangiography in detecting surgically documented left ventricular thrombi.

To assess the diagnostic value of various imaging techniques for identifying left ventricular thrombi, we studied 35 patients who underwent left ventricular aneurysm repair and inspection of the ventricular cavity for the presence of a thrombus. All patients underwent preoperative two-dimensional echocardiography and left ventricular cineangiography; radionuclide ventriculography was also performed in 19 of these patients. Data from these procedures were analyzed as in a blind study, and were interpreted as either positive or negative for thrombus. A left ventricular thrombus was present in 22 of the 35 patients at surgery (63%). Two-dimensional echocardiography showed a sensitivity of 95%, specificity of 92% and overall predictive accuracy of 94% for the detection or exclusion of thrombi. In comparison, cineangiography yielded a sensitivity of 73%, specificity of 92% and predictive accuracy of 80%. The sensitivity of radionuclide ventriculography was 60%, specificity was 100%, and predictive accuracy was 79%. Our data, based on a surgical-pathological standard, shows that two-dimensional echocardiography is a highly accurate technique for the diagnosis of left ventricular thrombi, and may be the procedure of choice for this purpose.