Two dimensional echocardiography in the diagnosis of left ventricular thrombus. A prospective study of 67 patients with anatomic validation.

Seventy-two patients, in whom a high prevalence of left ventricular thrombus (LVT) was anticipated, were studied prospectively by two-dimensional echocardiography (2DE). Adequate echocardiograms were obtained in 67 patients (93 percent). Presence or absence of LVT was verified at surgery in 51 patients undergoing aneurysmectomy, and at autopsy in 16 patients dying from acute myocardial infarction. Twenty-six patients had LVT and 41 did not. The LVT was defined echocardiographically as an echo-dense mass adjacent to asynergic left ventricular wall and distinct from the endocardial surface. Twenty-four of 26 LVT were correctly predicted by 2DE (sensitivity 92 percent). Absence of LVT was correctly predicted in 36 of 41 patients (specificity 88 percent). In five patients, LVT by 2DE was not anatomically confirmed (17 percent false positives). Thus, 2DE can detect or exclude the presence of LVT with a good sensitivity and specificity.