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DE-CMR reveals LV thrombus
J Am Coll Cardiol 2008; 52: 148-157
4 July 2008
MedWire News: Left ventricular (LV) thrombus detection can be improved by using delayed-enhancement cardiovascular magnetic resonance (DE-CMR) imaging, US researchers say.
The technique, which uses tissue contrast uptake to distinguish between thrombus and myocardium, revealed significantly more episodes in patients with systolic dysfunction than did anatomical pictures produced by cine-cardiovascular magnetic resonance (cine-CMR).
"As LV thrombus provides a substrate for thromboembolic events and a rationale for anticoagulation, thrombus detection using DE-CMR holds the potential to improve therapeutic decision-making and clinical care of patients with systolic dysfunction," say Raymond Kim (Duke University Medical Center, Durham, North Carolina) and colleagues.
The team examined the prevalence of thrombus in 784 patients with a LV ejection fraction of less than 50% using DE-CMR and cine-CMR.
Overall, DE-CMR detected significantly more thrombus than cine-CMR, at 7.0% and 4.7%, respectively.
DE-CMR identified thrombus in all five patients with pathology confirmed thrombus, whereas cine-CMR identified just two of these thrombi. In particular, cine-CMR missed small intracavitary, and small or large mural thrombi that were picked up by DE-CMR.
In the 6 months after CMR, patients with DE-CMR-detected thrombi were seven times more likely to have a cerebrovascular accident or transient ischemic attack or have pathologic confirmation of thrombus than patients without thrombus on DE-CMR (15.1% vs 2.1%). In comparison, cine-CMR-detected thrombus only increased the risk for these outcomes three-fold (8.6% vs 2.8%).
Multivariate analysis showed that thrombus was significantly predicted by myocardial scarring on DE-CMR imaging - a novel marker - as well as conventional indices such as low LVEF and ischemic cardiomyopathy.
"This study shows that DE-CMR is a clinically useful tool for the detection of LV thrombus," Kim et al write in the Journal of the American College of Cardiology.
They conclude: "Further investigation is needed to ascertain whether DE-CMR findings can be used to guide anticoagulant therapy and improve clinical outcomes among the growing population of patients with heart failure at risk for LV thrombus and related complications."
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