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. 2024 Mar;113(3):446-455.
doi: 10.1007/s00392-023-02317-x. Epub 2023 Oct 16.

Safety of dobutamine or adenosine stress cardiac magnetic resonance imaging in patients with left ventricular thrombus

Lukas D Weberling  1   2 , Sebastian Seitz  3 , Janek Salatzki  4   5 , Andreas Ochs  4   5 , Jannick Heins  4 , Ailís C Haney  4 , Deborah Siry  4 , Norbert Frey  4   5 , Florian André  4   5 , Henning Steen  4
Affiliations

Safety of dobutamine or adenosine stress cardiac magnetic resonance imaging in patients with left ventricular thrombus

Lukas D Weberling et al. Clin Res Cardiol. 2024 Mar.

Abstract

Background: Left ventricular (LV) thrombus formation is a common but potentially serious complication, typically occurring after myocardial infarction. Due to perceived high thromboembolic risk and lack of safety data, stress cardiac magnetic resonance (CMR) imaging especially with dobutamine is usually avoided despite its high diagnostic yield. This study aimed to investigate the characteristics, safety and outcome of patients with LV thrombus undergoing dobutamine or vasodilator stress CMR.

Methods: Patients undergoing stress CMR with concomitant LV thrombus were retrospectively included. Risk factors, comorbidities, and previous embolic events were recorded. Periprocedural safety was assessed for up to 48 h following the examination. Major adverse cardiac events (MACE) 12 months before the diagnosis were compared to 12 months after the exam and between patients and a matched control group. Additionally, patients were followed up for all-cause mortality.

Results: 95 patients (78 male, 65 ± 10.7 years) were included. Among them, 43 patients underwent dobutamine (36 high-dose, 7 low-dose) and 52 vasodilator stress CMR. Periprocedural safety was excellent with no adverse events. During a period of 24 months, 27 MACE (14.7%) occurred in patients and controls with no statistical difference between groups. During a median follow-up of 33.7 months (IQR 37.6 months), 6 deaths (6.3%) occurred. Type of stress agent, thrombus mobility, or protrusion were not correlated to embolic events or death.

Conclusion: The addition of a stress test to a CMR exam is safe and does increase the generally high cardioembolic event rate in LV thrombus patients. Therefore, it is useful to support reperfusion decision-making.

Keywords: Adenosine; CMR; Cardiovascular imaging; Dobutamine; LV thrombus; Stroke.

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Conflict of interest statement

The authors declare that they have no conflict of interests.

Figures

Fig. 1
Fig. 1
Image examples of six patients (1–6) with an LV thrombus on cine images (arrows) or late gadolinium enhancement images (white arrowheads). Detection of a thrombus may be difficult on cine images in some cases but is much easier on Late Gadolinium Enhancement images. Extensive transmural myocardial scar can be seen (red arrowheads) as predisposing factor for thrombus development. Patients either received high-dose dobutamine (1,3,6), low-dose dobutamine (2), or vasodilator stress with adenosine (4,5)
Fig. 2
Fig. 2
Thrombus resolution and choice of contrast agent in the study group. No statistical significance between choice of contrast agent and thrombus resolution was found
Fig. 3
Fig. 3
Event rates of MACE of the study group and an age-, sex- and ejection fraction-matched control group in the 12 months prior compared to 12 months after CMR. A Kaplan–Meier curve shows a graphical illustration of event rates for MACE with the vertical line indicating the time of CMR with subsequent diagnosis of LV thrombus and (in many cases) therapeutic changes. *Data available for 89 patients. °Per study design patients with death before CMR were not included in the study, therefore they are underrepresented and cannot be compared between groups
See this image and copyright information in PMC

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