title: Differentiation between fresh and old left ventricular thrombi by deformation imaging.
abstract: BACKGROUND
  Noninvasive echocardiographic differentiation between old and fresh left ventricular thrombi after myocardial infarction would be of clinical importance to estimate the risk for embolization and the necessity of anticoagulation.
  
  
  RESULTS
  Fifty-two patients, aged 41 to 87 years, with a thrombus after myocardial infarction were included in this 2-part study: In substudy-I, 20 patients, 10 each with a definite diagnosis of fresh or old thrombus, were included. In the subsequent prospective substudy-II, 32 consecutive patients with an incident thrombus after myocardial infarction but unknown thrombus age were started on phenprocoumon and followed for 6 months. Data on medical history, standard echocardiography, strain-rate (SR) imaging and magnetic resonance tomography were analyzed. In substudy-I, analysis of thrombus deformation revealed the most rapid change in SR during the isovolumetric relaxation period when cavity pressure decreases rapidly. Fresh (range: 5-27 days) and old thrombi (4-26 months) could be discriminated without overlap by peak SR during the isovolumetric relaxation period, using a cutoff value of 1 s(-1). Applying this threshold value in substudy-II, 17 thrombi were echocardiographically classified as fresh (=SR ≥1 s(-1)) and 15 as old. After 6 months in the fresh thrombus group, 16 of 17 thrombi had disappeared (94%), and in 1 patient the thrombus size was diminished by >50% (now presenting an old thrombus SR pattern). In contrast, 14 of the 15 old thrombi remained unchanged in size and deformation (1 thrombus disappeared).
  
  
  CONCLUSIONS
  Fresh and old intracavitary thrombi can be reliably differentiated by deformation imaging. In fresh thrombi, anticoagulation with phenprocoumon results in thrombus resolution in most patients.
authors: Comprehensive Heart Failure Center, Department of Internal Medicine I, Institute of Radiology, University of Wuerzburg, Oberdürrbacher Strasse 6, Würzburg, Germany.
authors: Markus
authors: M
authors: Niemann
authors: Philipp Daniel
authors: PD
authors: Gaudron
authors: Bart
authors: B
authors: Bijnens
authors: Stefan
authors: S
authors: Störk
authors: Meinrad
authors: M
authors: Beer
authors: Hanns
authors: H
authors: Hillenbrand
authors: Maja
authors: M
authors: Cikes
authors: Sebastian
authors: S
authors: Herrmann
authors: Kai
authors: K
authors: Hu
authors: Georg
authors: G
authors: Ertl
authors: Frank
authors: F
authors: Weidemann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003937:Diagnosis, Differential; D015150:Echocardiography, Doppler; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D005858:Germany; D006331:Heart Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D010644:Phenprocoumon / Q000627:therapeutic use; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013927:Thrombosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D013997:Time Factors
chemical_list: D000925:Anticoagulants; D010644:Phenprocoumon