Differentiation Between Fresh and Old Left Ventricular Thrombi by Deformation Imaging.
Circ Cardiovasc Imaging. 2012 Jul 5;
Authors: Niemann M, Gaudron PD, Bijnens B, StÃ¶rk S, Beer M, Hillenbrand H, Cikes M, Herrmann S, Hu K, Ertl G, Weidemann F
BACKGROUND: -Non-invasive echocardiographic differentiation between old and fresh left ventricular thrombi after myocardial infarction would be of clinical importance to estimate the risk for embolisation and the necessity of anticoagulation. METHODS AND RESULTS: -Fifty-two patients, aged 41-87 years, with a thrombus after myocardial infarction were included in this two-parted study: In sub-study-I 20 patients, 10 each with a definite diagnosis of fresh and old thrombus, were included. In the subsequent prospective sub-study-II 32 consecutive patients with an incident thrombus after myocardial infarction but unknown thrombus age were started on phenprocoumon and followed for six months. Data on medical history, standard-echocardiography, strain-rate-imaging and magnetic-resonance-tomography were analyzed. In sub-study-I, analysis of thrombus deformation revealed the most rapid change in strain-rate 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 strain-rate during the isovolumetric-relaxation-period, using a cut-off value of 1 s(-1). Applying this threshold value in sub-study-II, 17 thrombi were echocardiographically classified as "fresh" (=strain-rate â¥1 s(-1)) and 15 as "old". After six months in the fresh thrombus group, 16 out of 17 thrombi had disappeared (94%), and in one patient the thrombus size was diminished by >50% (now presenting an "old thrombus strain-rate 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.
PMID: 22767653 [PubMed - as supplied by publisher]