Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1985 Jan;53(1):36–42. doi: 10.1136/hrt.53.1.36

Comparative recognition of left ventricular thrombi by echocardiography and cineangiography.

T Takamoto, D Kim, P M Urie, D F Guthaner, H J Gordon, A Keren, R L Popp
PMCID: PMC481718  PMID: 3966950

Abstract

Studies performed in 47 patients, 11 of whom underwent surgery for aneurysmectomy and 36 of whom underwent cardiac transplantation, were reviewed to assess the diagnostic accuracies of cross sectional echocardiography and cineangiography in detecting left ventricular mural thrombi and the effect of anticoagulation treatment on the incidence of such thrombi. Cross sectional echocardiography in 37 patients and cineangiography in 26 (16 patients were examined by both methods) were analysed independently by sets of two observers experienced in the respective methods. All four observers were blinded to the pathological or surgical findings regarding mural thrombus. Mural thrombus was confirmed by pathological investigation in 14 of 47 (30%) cases; 11 of these 14 patients had intra-aneurysmal thrombi. The negative predictive value was quite good for both methods, but cross sectional echocardiography had a superior positive predictive value. This was due both to detailed soft tissue resolution by cross sectional echocardiography and to overdetection of mural thrombi by cineangiography in cases of aneurysms without mural thrombi. Mural thrombi were present in three of 20 patients with preceding anticoagulation and in 10 of 19 patients without anticoagulation. The results emphasise that cross sectional echocardiography is more reliable than cineangiography in recognising thrombi.

Full text

PDF
36

Images in this article

38Image
on p.38
38Image
on p.38
39Image
on p.39
39Image
on p.39

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Asinger R. W., Mikell F. L., Sharma B., Hodges M. Observations on detecting left ventricular thrombus with two dimensional echocardiography: emphasis on avoidance of false positive diagnoses. Am J Cardiol. 1981 Jan;47(1):145–156. doi: 10.1016/0002-9149(81)90303-9. [DOI] [PubMed] [Google Scholar]
  2. DOSCHER N., POINDEXTER C. A. Myocardial infarction without anticoagulant therapy; deaths, emboli and an analysis of factors influencing mortality. Am J Med. 1950 May;8(5):623–633. doi: 10.1016/0002-9343(50)90309-3. [DOI] [PubMed] [Google Scholar]
  3. DeJoseph R. L., Shiroff R. A., Levenson L. W., Martin C. E., Zelis R. F. Echocardiographic diagnosis of intraventricular clot. Chest. 1977 Mar;71(3):417–419. doi: 10.1378/chest.71.3.417. [DOI] [PubMed] [Google Scholar]
  4. DeMaria A. N., Bommer W., Neumann A., Grehl T., Weinart L., DeNardo S., Amsterdam E. A., Mason D. T. Left ventricular thrombi identified by cross-sectional echocardiography. Ann Intern Med. 1979 Jan;90(1):14–18. doi: 10.7326/0003-4819-90-1-14. [DOI] [PubMed] [Google Scholar]
  5. Ezekowitz M. D., Burrow R. D., Heath P. W., Streitz T., Smith E. O., Parker D. E. Diagnostic accuracy of indium-111 platelet scintigraphy in identifying left ventricular thrombi. Am J Cardiol. 1983 Jun;51(10):1712–1716. doi: 10.1016/0002-9149(83)90216-3. [DOI] [PubMed] [Google Scholar]
  6. Godwin J. D., Herfkens R. J., Skiöldebrand C. G., Brundage B. H., Schiller N. B., Lipton M. J. Detection of intraventricular thrombi by computed tomography. Radiology. 1981 Mar;138(3):717–721. doi: 10.1148/radiology.138.3.7465852. [DOI] [PubMed] [Google Scholar]
  7. Hamby R. I., Wisoff B. G., Davison E. T., Hartstein M. L. Coronary artery disease and left ventricular mural thrombi: clinical, hemodynamic and angiocardiographic aspects. Chest. 1974 Nov;66(5):488–494. doi: 10.1378/chest.66.5.488. [DOI] [PubMed] [Google Scholar]
  8. Horgan J. H., Shiel F. O., Goodman A. C. Demonstration of left ventricular thrombus by conventional echocardiography. J Clin Ultrasound. 1976 Aug;4(4):287–288. doi: 10.1002/jcu.1870040411. [DOI] [PubMed] [Google Scholar]
  9. Kallichurum S. The heart in cardiomyopathy: a postmortem study. S Afr Med J. 1976 Sep 25;50(41):1585–1591. [PubMed] [Google Scholar]
  10. Keating E. C., Gross S. A., Schlamowitz R. A., Glassman J., Mazur J. H., Pitt W. A., Miller D. Mural thrombi in myocardial infarctions. Prospective evaluation by two-dimensional echocardiography. Am J Med. 1983 Jun;74(6):989–995. doi: 10.1016/0002-9343(83)90798-2. [DOI] [PubMed] [Google Scholar]
  11. Kramer N. E., Rathod R., Chawla K. K., Patel R., Towne W. D. Echocardiographic diagnosis of left ventricular mural thrombi occurring in cardiomyopathy. Am Heart J. 1978 Sep;96(3):381–383. doi: 10.1016/0002-8703(78)90050-9. [DOI] [PubMed] [Google Scholar]
  12. Meltzer R. S., Guthaner D., Rakowski H., Popp R. L., Martin R. P. Diagnosis of left ventricular thrombi by two-dimensional echocardiography. Br Heart J. 1979 Sep;42(3):261–265. doi: 10.1136/hrt.42.3.261. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Mikell F. L., Asinger R. W., Elsperger K. J., Anderson W. R., Hodges M. Regional stasis of blood in the dysfunctional left ventricle: echocardiographic detection and differentiation from early thrombosis. Circulation. 1982 Oct;66(4):755–763. doi: 10.1161/01.cir.66.4.755. [DOI] [PubMed] [Google Scholar]
  14. Mikell F. L., Asinger R. W., Elsperger K. J., Anderson W. R., Hodges M. Tissue acoustic properties of fresh left ventricular thrombi and visualization by two dimensional echocardiography: experimental observations. Am J Cardiol. 1982 Apr 1;49(5):1157–1165. doi: 10.1016/0002-9149(82)90040-6. [DOI] [PubMed] [Google Scholar]
  15. Popp R. L., Fowles R., Coltart D. J., Martin R. P. Cardiac anatomy viewed systematically with two dimensional echocardiography. Chest. 1979 May;75(5):579–585. doi: 10.1378/chest.75.5.579. [DOI] [PubMed] [Google Scholar]
  16. Ports T. A., Cogan J., Schiller N. B., Rapaport E. Echocardiography of left ventricular masses. Circulation. 1978 Sep;58(3 Pt 1):528–536. doi: 10.1161/01.cir.58.3.528. [DOI] [PubMed] [Google Scholar]
  17. Raphael M. J., Steiner R. E., Goodwin J. F., Oakley C. M. Cine angiography of left ventricular aneurysms. Clin Radiol. 1972 Apr;23(2):129–139. doi: 10.1016/s0009-9260(72)80074-6. [DOI] [PubMed] [Google Scholar]
  18. Reeder G. S., Lengyel M., Tajik A. J., Seward J. B., Smith H. C., Danielson G. K. Mural thrombus in left ventricular aneurysm: incidence, role of angiography, and relation between anticoagulation and embolization. Mayo Clin Proc. 1981 Feb;56(2):77–81. [PubMed] [Google Scholar]
  19. Reeder G. S., Tajik A. J., Seward J. B. Left ventricular mural thrombus: two-dimensional echocardiographic diagnosis. Mayo Clin Proc. 1981 Feb;56(2):82–86. [PubMed] [Google Scholar]
  20. Simpson M. T., Oberman A., Kouchoukos N. T., Rogers W. J. Prevalence of mural thrombi and systemic embolization with left ventricular aneurysm. Effect of anticoagulation therapy. Chest. 1980 Apr;77(4):463–469. doi: 10.1378/chest.77.4.463. [DOI] [PubMed] [Google Scholar]
  21. Stratton J. R., Lighty G. W., Jr, Pearlman A. S., Ritchie J. L. Detection of left ventricular thrombus by two-dimensional echocardiography: sensitivity, specificity, and causes of uncertainty. Circulation. 1982 Jul;66(1):156–166. doi: 10.1161/01.cir.66.1.156. [DOI] [PubMed] [Google Scholar]
  22. Stratton J. R., Ritchie J. L., Hammermeister K. E., Kennedy J. W., Hamilton G. W. Detection of left ventricular thrombi with radionuclide angiography. Am J Cardiol. 1981 Sep;48(3):565–572. doi: 10.1016/0002-9149(81)90089-8. [DOI] [PubMed] [Google Scholar]
  23. Swan H. J., Magnusson P. T., Buchbinder N. A., Matloff J. M., Gray R. J. Aneurysm of the cardiac ventricle. Its management by medical and surgical intervention. West J Med. 1978 Jul;129(1):26–40. [PMC free article] [PubMed] [Google Scholar]
  24. Tomoda H., Hoshiai M., Furuya H., Kuribayashi S., Ootaki M., Matsuyama S., Koide S., Kawada S., Shotsu A. Evaluation of intracardiac thrombus with computed tomography. Am J Cardiol. 1983 Mar 1;51(5):843–852. doi: 10.1016/s0002-9149(83)80143-x. [DOI] [PubMed] [Google Scholar]
  25. van Meurs-van Woezik H., Meltzer R. S., van den Brand M., Essed C. E., Michels R. H., Roelandt J. Superiority of echocardiography over angiocardiography in diagnosing a left ventricular thrombus. Chest. 1981 Sep;80(3):321–323. doi: 10.1378/chest.80.3.321. [DOI] [PubMed] [Google Scholar]
  26. van den Bos A. A., Vletter W. B., Hagemeijer F. Progressive development of a left ventricular thrombus. Chest. 1978 Sep;74(3):307–309. doi: 10.1378/chest.74.3.307. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES