Title: Thrombotic Complications in Dilated Cardiomyopathy Patients-Comparative Study Using Echocardiography and Cardiac MRI
Authors: Dr Imtiyaz Ahmad Khan, Dr Manjeet Singh, Dr Rameez Mohiudin
DOI: https://dx.doi.org/10.18535/jmscr/v8i2.46
Abstract
Objectives: Comparison between Echocardiography and Cardiac MRI in detection of intraventricular thrombi in Dilated cardiomyopathy patients.
Methods: Sixty Patients of DCM with reduced LV EF (<50%) were enrolled in this study.
All echocardiographic studies were performed on Aloka USG by an experienced cardiologist.
All Cardiac MR Studies were performed on 1.5 Tesla MRI .Obtained data was analyzed on Siemens Workstation.
Data was analyzed using Analysis of variance technique (ANOVA), Pearson’s correlational coefficient and Students t-test. A P-value of <0.05 was taken as significant. Bland-Altman method was used for comparison between EF values and ventricular volumes.
Observations: MRI showed ventricular thrombi in 9 out of 60 patients with average size of 1 to 9 cm3. Of the detected thrombi 6 were localized at ventricular apex and three were visualized at anteroseptal wall.
Trans-thoracic Echocardiography showed ventricular thrombus in 2 patients located in LV apex with average size of 4 cm3.
Taking MRI as gold standard for detection of intra-ventricular thrombi; Sensitivity of Echo For Thrombi Detection=33.4%.
Difference in EF on MRI between patients with and without ventricular thrombi was 8.96 (P=0.020).
Presence of intraventricular thrombi correlated with an increased left ventricular end diastolic volume.(P=0.010)
Conclusion
- CARDIAC MRI is a better modality in identification of LV thrombi in DCM patients.
Presence of intra-ventricular thrombi correlates with lower EF and increased Left ventricular end diastolic volumes.
References
- Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics - 2011 update: a report from the American Heart Association Circulation 2011 ; 123 (4 ): e18-e209.
- F. Armstrong and T. Ryan, Dilated Cardiomyopathy. Feigenbaum's Echocardiography, Lippincott Wilkins & Wilkins, Philadelphia, Pa, USA, 7th edition, 2010
- S. Gottdiener, J. A. Gay, L. Van Voorhees, R. DiBianco, and R. D. Fletcher, “Frequency and embolic potential of left ventricular thrombus in dilated cardiomyopathy: assessment by 2-dimensional echocardiography,” The American Journal of Cardiology, vol. 52, no. 10, pp. 1281–1285, 1983.
- Billingsley and H. Leong-poi, “Left ventricular thrombus: diagnosis, prevention and management,” Cardiology Rounds, vol. X, no. 7, 2005
- D. Sharma, P. A. McCullough, E. F. Philbin, and W. D. Weaver, “Left ventricular thrombus and subsequent thromboembolism in patients with severe systolic dysfunction,” Chest, vol. 117, no. 2, pp. 314–320, 2000.
- Nair, B. Sealove, J. L. Halperin, G. Webber, and V. Fuster, “Anticoagulation in patients with heart failure: who, when, and why?” European Heart Journal, Supplement, vol. 8, pp. E32–E38, 2006
- Vaitkus PT, Barnathan ES. Embolic potential, prevention and management of mural thrombus complicating anterior myocardial infarction: a meta-analysis. J Am Coll Cardiol. 1993;22:1004–1009.
- Delewi, F. Zijlstra, and J. J. Piek, “Left ventricular thrombus formation after acute myocardial infarction,” Heart, vol. 98, no. 23, pp. 1743–1749, 2012.
- Visser CA, Kan G, David GX, et al. Two-dimensional echocardiography in the diagnosis of left ventricular thrombus: a prospective study of 67 patients with anatomic validation. Chest. 1983;83:228–232.
- Bruder O, Waltering KU, et al. Detection and characterization of left ventricular thrombi by MRI compared to transthoracic echocardiography. 2005 Mar; 177 (3):344-9.
- Lipke C, Katoh M et al. The value of non-contrast harmonic transthoracic echocardiography for the detection of left ventricular thrombi in patients with cardiomyopathy: comparison with contrast-enhanced magnetic resonance imaging. Int J Cardiovasc Imaging. 2007 Aug; 23(4): 479-87
- W. Weinsaft, H. W. Kim, A. L. Crowley et al., “LV thrombus detection by routine echocardiography: insights into performance characteristics using delayed enhancement CMR,” Journal of the American College of Cardiology, vol. 4, no. 7, pp. 702–712, 2011.
- Nico R. Mollet, Steven Dymarkowsk et al. Visualization of Ventricular Thrombi With Contrast-Enhanced Magnetic Resonance Imaging in Patients With Ischemic Heart Disease. Circulation 2002;106:2873-2876.
- Bruder O, Waltering KU, et al. Detection and characterization of left ventricular thrombi by MRI compared to transthoracic echocardiography. 2005 Mar;177 (3):344-9.