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.
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.
Authors: Ramon Castello; Jonathan N Bella; Aleksandr Rovner; Jimmy Swan; John Smith; Leslie Shaw Journal: Am Heart J Date: 2003-03 Impact factor: 4.749
Authors: Roberto M Lang; Michelle Bierig; Richard B Devereux; Frank A Flachskampf; Elyse Foster; Patricia A Pellikka; Michael H Picard; Mary J Roman; James Seward; Jack S Shanewise; Scott D Solomon; Kirk T Spencer; Martin St John Sutton; William J Stewart Journal: J Am Soc Echocardiogr Date: 2005-12 Impact factor: 5.251
Authors: Burkhard Sievers; Michael D Elliott; Lynne M Hurwitz; Timothy S E Albert; Igor Klem; Wolfgang G Rehwald; Michele A Parker; Robert M Judd; Raymond J Kim Journal: Circulation Date: 2007-01-02 Impact factor: 29.690
Authors: O P Simonetti; R J Kim; D S Fieno; H B Hillenbrand; E Wu; J M Bundy; J P Finn; R M Judd Journal: Radiology Date: 2001-01 Impact factor: 11.105
Authors: Monvadi B Srichai; Chelif Junor; L Leonardo Rodriguez; Arthur E Stillman; Richard A Grimm; Michael L Lieber; Joan A Weaver; Nicholas G Smedira; Richard D White Journal: Am Heart J Date: 2006-07 Impact factor: 4.749
Authors: Jonathan W Weinsaft; Han W Kim; Dipan J Shah; Igor Klem; Anna Lisa Crowley; Rhoda Brosnan; Olga G James; Manesh R Patel; John Heitner; Michele Parker; Eric J Velazquez; Charles Steenbergen; Robert M Judd; Raymond J Kim Journal: J Am Coll Cardiol Date: 2008-07-08 Impact factor: 24.094
Authors: Lisa L Kusnetzky; Adnan Khalid; Taiyeb M Khumri; Tabitha G Moe; Philip G Jones; Michael L Main Journal: J Am Coll Cardiol Date: 2008-04-09 Impact factor: 24.094
Authors: Jonathan W Weinsaft; Han W Kim; Anna Lisa Crowley; Igor Klem; Chetan Shenoy; Lowie Van Assche; Rhoda Brosnan; Dipan J Shah; Eric J Velazquez; Michele Parker; Robert M Judd; Raymond J Kim Journal: JACC Cardiovasc Imaging Date: 2011-07
Authors: Edmond M Cronin; Frank M Bogun; Philippe Maury; Petr Peichl; Minglong Chen; Narayanan Namboodiri; Luis Aguinaga; Luiz Roberto Leite; Sana M Al-Khatib; Elad Anter; Antonio Berruezo; David J Callans; Mina K Chung; Phillip Cuculich; Andre d'Avila; Barbara J Deal; Paolo Della Bella; Thomas Deneke; Timm-Michael Dickfeld; Claudio Hadid; Haris M Haqqani; G Neal Kay; Rakesh Latchamsetty; Francis Marchlinski; John M Miller; Akihiko Nogami; Akash R Patel; Rajeev Kumar Pathak; Luis C Saenz Morales; Pasquale Santangeli; John L Sapp; Andrea Sarkozy; Kyoko Soejima; William G Stevenson; Usha B Tedrow; Wendy S Tzou; Niraj Varma; Katja Zeppenfeld Journal: J Interv Card Electrophysiol Date: 2020-10 Impact factor: 1.900
Authors: Pratik S Velangi; Christopher Choo; Ko-Hsuan A Chen; Felipe Kazmirczak; Prabhjot S Nijjar; Afshin Farzaneh-Far; Osama Okasha; Mehmet Akçakaya; Jonathan W Weinsaft; Chetan Shenoy Journal: Circ Cardiovasc Imaging Date: 2019-11-11 Impact factor: 7.792
Authors: Dennis T L Wong; James D Richardson; Rishi Puri; Adam J Nelson; Angela G Bertaso; Karen S L Teo; Matthew I Worthley; Stephen G Worthley Journal: Eur Radiol Date: 2012-03-25 Impact factor: 5.315
Authors: Jonathan W Weinsaft; Jiwon Kim; Chaitanya B Medicherla; Claudia L Ma; Noel C F Codella; Nina Kukar; Subhi Alaref; Raymond J Kim; Richard B Devereux Journal: JACC Cardiovasc Imaging Date: 2015-10-14