Improved detection of left ventricular thrombi and spontaneous echocontrast by tissue harmonic imaging in patients with myocardial infarction.
BACKGROUND
Tissue harmonic imaging (THI) reduces near-field and side-lobe artifacts. This could improve recognition of cardiac masses, including thrombi and spontaneous echocontrast (SEC), a known thromboembolic risk factor.


OBJECTIVE
We tested the hypothesis that THI improves detection of left ventricular (LV) thrombi and SEC compared with transthoracic fundamental imaging in patients with recent myocardial infarction.


METHODS
In all, 118 consecutive patients with recent myocardial infarction were studied at predischarge. The echocardiographic examination was performed in both fundamental imaging and THI modality and evaluated by 3 skilled and 3 nonexperienced observers for recognition of LV thrombosis and SEC.


RESULTS
THI increased LV thrombi diagnosis by 25% by skilled observers and by 50% by nonexperienced readers, reducing the number of false-positive diagnoses by 67%. Also, compared with fundamental imaging, THI improved recognition of LV SEC by both experienced and nonexperienced observers by 56% and 62%, respectively.


CONCLUSIONS
The improved recognition of LV thrombosis and SEC by THI in patients with myocardial infarction is clinically relevant allowing appropriate treatment and prognostic stratification. Therefore, routine use of THI should be recommended when studying such patients in clinical practice.
Mele
Donato
D
Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, and Centro di Fisiopatologia Cardiovascolare Salvatore Maugeri, Foundation IRCCS, Ferrara, Italy. donatomele@libero.it <donatomele@libero.it>
Soukhomovskaia
Olga
O
Pacchioni
Emanuele
E
Merli
Elisa
E
Avigni
Nicola
N
Federici
Luca
L
Levine
Robert A
RA
Ferrari
Roberto
R
D000465:Algorithms; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging*; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging*