Value of contrast echocardiography for left ventricular thrombus detection postinfarction and impact on antithrombotic therapy

Abstract

Introduction: Conventional echocardiography is often inconclusive for the presence or the absence of left ventricular (LV) thrombus. Contrast echocardiography could have additional diagnostic and therapeutic significance. This analysis investigated the value of contrast echocardiography for LV thrombus detection in patients postinfarction and the impact on choice of antithrombotic therapy.

Methods: From a cohort of 991 patients undergoing routine echocardiography postinfarction, 156 patients who underwent additional contrast echocardiography formed the study population. Changes in antithrombotic therapy were noted.

Results: Characteristics of the 156 analyzed patients were: age 62+/-12 years, 88% male, 85% anterior infarction. Conventional echocardiography was inconclusive for LV thrombus in 123 patients and in 33 patients LV thrombus was suspected. With the use of contrast agent, all 123 echocardiographic studies turned conclusive: 14 patients had LV thrombus and in 109 patients LV thrombus was absent. In 33 patients with suspected LV thrombus, thrombus was ruled out in 13 (39%) patients, whereas thrombus was confirmed in 20 patients. In total, 34 patients had LV thrombus confirmed with contrast echocardiography. As a consequence, in 23 of 34 (68%) patients, antithrombotic therapy was upgraded from antiplatelet aggregation to oral anticoagulants. Moreover, unnecessary anticoagulation therapy was avoided in the 13 of 33 (39%) patients ruled out for LV thrombus with contrast echocardiography.

Conclusion: Contrast echocardiography in post-infarction patients can detect LV thrombus when conventional echocardiography is inconclusive and can unmask artifacts or myocardial structures initially suspect for LV thrombus. Contrast echocardiography changed antithrombotic therapy in 68% of patients with confirmed LV thrombus.