Echocardiography vs. Cardiac Magnetic Resonance Imaging for the Diagnosis of Left Ventricular Thrombus: A Systematic Review.
BACKGROUND
Left ventricular (LV) thrombi can occur in the setting of LV dysfunction especially in the acute postmyocardial infarction period. The ideal imaging strategy to detect LV thrombi is currently unknown. The objective of this study was to conduct a systematic review to compare the accuracy of transthoracic echocardiography (TTE) with that of cardiac magnetic resonance (CMR) imaging for the detection of LV thrombi.


METHODS
OvidMEDLINE, EMBASE, and Cochrane databases were searched for articles published between January 1, 1946 and July 31, 2013. After screening of all potentially relevant abstracts and articles, 7 studies were ultimately selected for this review.


RESULTS
Our results suggest that late gadolinium enhancement CMR imaging is the most accurate modality for the detection of LV thrombi (sensitivity 88%, specificity 99%), followed by cine-CMR imaging (sensitivity 58%-79%, specificity 99%, accuracy 95%, positive predictive value 93%-95%, negative predictive value 95%-96%), contrast TTE (sensitivity 23%-61%, specificity 96%-99%, accuracy 92%, positive predictive value 93%, negative predictive value 91%), and, finally, noncontrast TTE (sensitivity 24%-33%, specificity 94%-95%, accuracy 82%, positive predictive value 57%, negative predictive value 85%). Accuracy of TTE might be improved if a clear clinical indication is provided and with routine use of LV opacifying contrast agents.


CONCLUSIONS
Our findings indicate that late gadolinium enhancement CMR imaging is the most accurate sequence in the detection of LV thrombus, and should be favoured when there is a high index of suspicion. When CMR is contraindicated, unavailable, or impractical, our analysis argues for contrast-TTE in patients at high risk for developing LV thrombi.
Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Idan
I
Roifman
Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Kim A
KA
Connelly
Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.
Graham A
GA
Wright
Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada. Electronic address: harindra.wijeysundera@sunnybrook.ca.
Harindra C
HC
Wijeysundera
D000328:Adult; D000368:Aged; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D005682:Gadolinium; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology*; D018487:Ventricular Dysfunction, Left / Q000150:complications*
D005682:Gadolinium