Details
Category: Volume 11 Issue 10 October 2023
Hits: 451

Title: Contrast Tuned Imaging for Detection of Left Ventricular apical thrombus: A Case Report

Authors: Akhil Mehrotra, Mohammed Shaban, Shubham Kacker

 DOI: https://dx.doi.org/10.18535/jmscr/v11i10.01

Abstract

Thrombi represent the most frequently found intracardiac masses. Left ventricular thrombus (LVT) is an important complication in patients with ischemic heart diseases and in those with dilated cardiomyopathy and systolic heart failure. The diagnosis of left ventricular thrombus remains important since anticoagulation will reduce the risk of systemic embolization and stroke. Despite advances in other imaging modalities, echocardiography remains the most important tool for diagnosis and risk stratification in patients predisposed to develop left ventricular thrombi. We are presenting a case report of  62 years old gentleman who had suffered from anterior wall myocardial infarction (AWMI) in the recent past, and now has developed LVT which was detected by contrast tuned imaging (CTI) technology based contrast echocardiography. This is a first case report of detection of LVT by this ingenious technology.

Keywords: Thrombus, Left Ventricle, Ischemic Heart Disease, Anterior Wall Myocardial Infarction, Contrast Tuned Imaging, Left Ventricular Opacification.

References

  1. Muthiah R, Left Ventricular “Horseshoe-Thrombus”- A Case Report. Case Report in Clinical Medicine, 2016; 5:140-146.
  2. Kalra, A. and Jang, I.K. Prevalence of Early Left Ventricular Thrombus after Primary Coronary Intervention for Acute Myocardial Infarction. Journal of Thrombosis and Thrombolysis, 2000; 10:133-136.
  3. Greaves, S.C., Zhi, G., Lee, R.T., et al. Incidence and Natural History of Left Ventricular Thrombus Following Anterior Wall Acute Myocardial Infarction. American Journal of Cardiology, 1997; 80:442-448.
  4. Nayak, D., Aronow, W.S., Sukhija, R., McClung, J.A., Monsen, C.E. and Belkin, R.N. Comparison of Frequency of Left Ventricular Thromb I in Patients with Anterior Wall versus Non-Anterior Wall Acute Myocardial Infarction Treated with Antithrombotic and Antiplatelet Therapy with or without Coronary Revascularization. American Journal of Cardiology, 2004; 93:1529-1530.
  5. Cacciapuoti, F., Varrichio, M., D'Avino, M., Gentile, S., Lama, D. and Cotrufo, M. Post Necrotic Endoventricular Thrombosis, Comparative Evaluation of the Diagnostic Reliability of 2-Dimensional Echocardiography and Cineventriculography. Gionale Italiano di Cardiologia, 1986; 16:344-349.
  6. Srichai, M.B., Junor, C., Rodriguez, L.L., et al. Clinical, Imaging, and Pathological Characteristics of Left Ventricular Thrombus; a Comparison of Contrast-Enhanced Magnetic Resonance Imaging, Transthoracic Echocardiography and Transesophagial Echocardiography with Surgical or Pathological Validation. American Heart Journal, 2006; 152:75-84.
  7. Asinger, R.W., Mikell, F.L., Sharma, B. and Hodges, M. Observations on Detecting Left Ventricular Thrombus with Two-Dimensional Echocardiography, Emphasis on Avoidance of False Positive Diagnoses. American Journal of Cardiology, 1981; 47:145-156.
  8. Haugland, J.M., Asinger, R.W., Mikell, F.L., Elsperger, J. and Hodges, M. Embolic Potential of Left Ventricular Thrombi Detected by Two-Dimensional Echocardiography. Circulation, 1984; 70:588-598.
  9. Olszewski R, Timperley J, Szmigielski C, Monaghan M, Nihoyannopoulos P, Senior R, Becher H. The clinical applications of contrast echocardiography. Eur J Echocardiography 2007; 8: S13-S23.
  10. Weinsaft JW, Kim RJ, Ross M, Krauser D, Manoushagian S, LaBounty TM, et al. Contrast-enhanced anatomic imaging as compared to contrast- enhanced tissue characterization for detection of left ventricular thrombus. JACC Cardiovasc Imaging. 2009; 2:969-79.
  11. Weinsaft JW, Kim HW, Crowley AL, et al. LV thrombus detection by routine echocardiography: insights into performance characteristics using delayed enhancement CMR. J Am Coll Cardiol Img. 2011; 4:702-12.
  12. Stratton JR, Resnick AD. Increased embolic risk in patients with left ventricular thrombi. Circulation, 1987; 75:1004-1011.
  13. Lehman EP, Cowper PA, Randolph TC, Kosinski AS, Lopes RD, Douglas PS. Usefulness and Cost-Effectiveness of Universal Echocardiographic Contrast to Detect Left Ventricular Thrombus in Patients with Heart Failure and Reduced Ejection Fraction. Am J Cardiol. 2018; 122:121-128.
  14. Contrat Tuned Imaging: Esoate, S.P.A, Genova, Italy: White Paper.
  15. Porter TR, Abdelmoneim S, Belcik JT, McCulloch ML, Mulvagh SL, Olson JJ, Porcelli C, Tsutsui JM, Wei K. Guidelines for the Cardiac Sonographer in the Performance of Contrast Echocardiography: A focus Update from the American Society of Echocardiography, J Am Soc Echocardiogr. 2014; 27:797-810.
  16. Porter A, Kandalker H, lakobishvili Z, Sagie A, Imbar S, Battler A, et al. Left ventricular mural thrombus after anterior ST-segment-elevation acute myocardial infarction in the era of aggressive reperfusion therapy - still a frequent complication. Coron Artery Dis. 2005; 6:275-9.
  17. Mehra, S., Movahed, A., Espinoza, C. and Marcu, C.B. Horseshoe Thrombus in a Patient with Mechanical Prosthetic Mitral Valve. A Case Report and Review of Literature. World Journal of Clinical Cases, 2015; 3:838-842.
  18. Mendichovszky IA, Marks SD, Simcock CM, Olsen OE. Gadolinium and nephrogenic systemic fibrosis: time to tighten practice. Pediatr Radiol. 2008; 38:489- 96.
  19. Ali-Barman H, Atici A, Erturk E, Faruk-Baycan O, Rasih-Sonsoz M, Betul-Medik Y, And Sahins I. Apical longitudinal strain can help predict the development of left ventricular thrombus after anterior myocardial infarction. Rev Invest Clin. 2020, 726:353-62.
  20. Garber AM, Mentz RJ, Al-Khalidi HR, Shaw LK, Fiuzat M, O'Connor CM, et al. Clinical predictors and outcomes of patients with left ventricular thrombus following ST-segment elevation myocardial infarction. J Thromb Thrombolysis. 2016; 41:365-73.
  21. Gianstefani S, Douiri A, Delithanasis I, Rogers T, Sen A, Kalra S, et al. Incidence and predictors of early left ventricular thrombus after ST-elevation myocardial infarction in the contemporary era of primary percutaneous coronary intervention. Am J Cardiol. 2014; 113:1111-6.
  22. Blessberger H, Binder T. Non-invasive imaging: two dimensional speckle tracking echocardiography: basic principles. Heart. 2010; 96:716-22.
  23. Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G, et al. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese society of echocardiography. J Am Soc Echocardiogr. 2011; 24:277-313

Corresponding Author

Dr. Akhil Mehrotra

Chief, Non Invasive Cardiologist, Pediatric and Adult Cardiology, Prakash Heart Station, D-16 Nirala Nagar, Lucknow, UP India