Value of contrast echocardiography for left ventricular  thrombus detection postinfarction and impact on  antithrombotic therapy.
BACKGROUND
Conventional echocardiography is often inconclusive for the presence or the absence of left ventricular (LV) thrombus. Contrast echocardiography could have additional diagnostic and therapeutic significance. This analysis investigated the value of contrast echocardiography for LV thrombus detection in patients postinfarction and the impact on choice of antithrombotic therapy.


METHODS
From a cohort of 991 patients undergoing routine echocardiography postinfarction, 156 patients who underwent additional contrast echocardiography formed the study population. Changes in antithrombotic therapy were noted.


RESULTS
Characteristics of the 156 analyzed patients were: age 62+/-12 years, 88% male, 85% anterior infarction. Conventional echocardiography was inconclusive for LV thrombus in 123 patients and in 33 patients LV thrombus was suspected. With the use of contrast agent, all 123 echocardiographic studies turned conclusive: 14 patients had LV thrombus and in 109 patients LV thrombus was absent. In 33 patients with suspected LV thrombus, thrombus was ruled out in 13 (39%) patients, whereas thrombus was confirmed in 20 patients. In total, 34 patients had LV thrombus confirmed with contrast echocardiography. As a consequence, in 23 of 34 (68%) patients, antithrombotic therapy was upgraded from antiplatelet aggregation to oral anticoagulants. Moreover, unnecessary anticoagulation therapy was avoided in the 13 of 33 (39%) patients ruled out for LV thrombus with contrast echocardiography.


CONCLUSIONS
Contrast echocardiography in post-infarction patients can detect LV thrombus when conventional echocardiography is inconclusive and can unmask artifacts or myocardial structures initially suspect for LV thrombus. Contrast echocardiography changed antithrombotic therapy in 68% of patients with confirmed LV thrombus.
Siebelink
Hans-Marc J
HM
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. h.j.siebelink@lumc.nl
Scholte
Arthur J H A
AJ
Van de Veire
Nico R
NR
Holman
Eduard R
ER
Nucifora
Gaetano
G
van der Wall
Ernst E
EE
Bax
Jeroen J
JJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D056988:Anterior Wall Myocardial Infarction / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D000925:Anticoagulants / Q000627:therapeutic use*; D016477:Artifacts; D003287:Contrast Media; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010743:Phospholipids; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013459:Sulfur Hexafluoride; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology; D014463:Ultrasonography
D000925:Anticoagulants; D003287:Contrast Media; D005343:Fibrinolytic Agents; D010743:Phospholipids; D010975:Platelet Aggregation Inhibitors; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride