Prevalence of intracardiac thrombi on cardiac computed tomography angiography: Outcome and impact on consequent management

Abstract

Objective: Intracardiac thrombi are intermittently come across on cardiac computed tomography angiography (CCTA). This study aimed to examine the prevalence, outcome, and prognosis in patients with incidental found left-sided cardiac thrombi on CCTA.

Material and methods: The Ethics Committee approved the present study of the Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. A retrospective review of CCTA was performed for incidental left-sided cardiac thrombi.

Results: A total of 1080 CCTAs were enrolled with the prevalence of incidental left-sided cardiac thrombi is 4.53%. Of the 49 patients with CCTA incidental left-sided cardiac thrombi, 16 had left atrial thrombi, and 33 had left ventricular thrombi. All thrombi were undetermined before the CCTA, and their identification subsequently generated anticoagulation treatment. In 10 patients, embolic complications happened, 4 of which were fatal. Patients with incidental detected left-sided intracardiac thrombi seen by CCTA had more embolic event than patients who did not discover left-sided intracardiac thrombi by CCTA (HR = 8.07; 95% CI 1.48-44.06; p = 0.016).

Conclusions: Incidental left-sided cardiac thrombi on CCTA guided to management adjustments and seemed to present substantial mortality and morbidity in the present study. Physicians who interpret CCTA should ensure a dedicated effort not to disregard these prospective pitfalls.

Keywords: Cardiac CTA; Cardiac thrombus; Computed tomography.

Fig. 1

Flow-chart of the patients’ inclusion in the study. (CCTA : Cardiac computed tomography angiography, LV: left ventricle, LA: left atrium)

Fig. 2

CCTA of a 66-year-old woman with atrial fibrillation and post central line removal. She was referred for CCTA to evaluate coronary artery disease. Incidental found thrombus in left atrial appendage (white arrow) and right atrium (black arrow) were demonstrated. (CCTA: Cardiac computed tomography angiography, RA: Right atrium, LA: Left atrium).

Fig. 3

Kaplan-Meier curve for embolic events for the patients with left-sided intracardiac thrombi detected by CCTA (red line) and the patients with normal CCTA (blue line). (CCTA: cardiac computed tomography angiography) (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article).

Fig. 4

A 63-year-old man was referred for CCTA to evaluate coronary artery bypass graft patency. Four chamber view (A) and short axis view (B) CCTA demonstrated incidental found left ventricular thrombus (arrows) adhere to the thin calcified left ventricular myocardium. (CCTA : Cardiac computed tomography angiography, RA : Right atrium, LA : Left atrium, RV : Right ventricle, LV : Left ventricle).

Fig. 5

A 69-year-old man was referred for CCTA to plan percutaneous coronary interventions (PCI) of left anterior descending artery occlusion. Short axis view (A) and 3D volume rendering technique image (B) CCTA reveals left ventricular aneurysm (dashed arrows) with mural thrombus (arrow). (CCTA : Cardiac computed tomography angiography, LV : Left ventricle).

Fig. 6

A rheumatic heart disease patient was sent for CCTA to diagnosis of anomalous coronary artery. Left atrial appendage thrombus was incidentally detected (arrow) and slow flow artifact within left atrial appendage also demonstrated (dashed arrow). (CCTA : Cardiac computed tomography angiography, RA : Right atrium, LA : Left atrium).