Loading…
Echocardiographic Algorithm for Post-Myocardial Infarction LV Thrombus: A Gatekeeper for Thrombus Evaluation by Delayed Enhancement CMR
The goal of this study was to determine the prevalence of post-myocardial infarction (MI) left ventricular (LV) thrombus in the current era and to develop an effective algorithm (predicated on echocardiography [echo]) to discern patients warranting further testing for thrombus via delayed enhancemen...
Saved in:
| Published in: | JACC. Cardiovascular imaging 2016-05, Vol.9 (5), p.505-515 |
|---|---|
| Main Authors: | , , , , , , , , |
| Format: | Article |
| Language: | English |
| Subjects: | |
| Online Access: | Get full text |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| cited_by | |
|---|---|
| cites | |
| container_end_page | 515 |
| container_issue | 5 |
| container_start_page | 505 |
| container_title | JACC. Cardiovascular imaging |
| container_volume | 9 |
| creator | Weinsaft, Jonathan W Kim, Jiwon Medicherla, Chaitanya B Ma, Claudia L Codella, Noel C F Kukar, Nina Alaref, Subhi Kim, Raymond J Devereux, Richard B |
| description | The goal of this study was to determine the prevalence of post-myocardial infarction (MI) left ventricular (LV) thrombus in the current era and to develop an effective algorithm (predicated on echocardiography [echo]) to discern patients warranting further testing for thrombus via delayed enhancement (DE) cardiac magnetic resonance (CMR).
LV thrombus affects post-MI management. DE-CMR provides thrombus tissue characterization and is a well-validated but an impractical screening modality for all patients after an MI.
A same-day echo and CMR were performed according to a tailored protocol, which entailed uniform echo contrast (irrespective of image quality) and dedicated DE-CMR for thrombus tissue characterization.
A total of 201 patients were studied; 8% had thrombus according to DE-CMR. All thrombi were apically located; 94% of thrombi occurred in the context of a left anterior descending (LAD) infarct-related artery. Although patients with thrombus had more prolonged chest pain and larger MI (p ≤ 0.01), only 18% had aneurysm on echo (cine-CMR 24%). Noncontrast (35%) and contrast (64%) echo yielded limited sensitivity for thrombus on DE-CMR. Thrombus was associated with stepwise increments in basal → apical contractile dysfunction on echo and quantitative cine-CMR; the echo-measured apical wall motion score was higher among patients with thrombus (p < 0.001) and paralleled cine-CMR decrements in apical ejection fraction and peak ejection rates (both p < 0.005). Thrombus-associated decrements in apical contractile dysfunction were significant even among patients with LAD infarction (p |
| doi_str_mv | 10.1016/j.jcmg.2015.06.017 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_1787480833</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1787480833</sourcerecordid><originalsourceid>FETCH-LOGICAL-p211t-d5371f11b7a254372a19927369117658bdbc75d3ac9fcc4ba9b85a9b1a65ccd03</originalsourceid><addsrcrecordid>eNo1kM1Og0AUhScmxtbqC7gws3QDzmWAAXdNxdqkjcZUt81lGAoVGBzAhDfwMXwWn0zSn809i_udk5xDyA0wGxj49zt7J8ut7TDwbObbDMQZGUMgfEt4IYzIZdPsGPOZ74oLMnIG8T3Gx-QnkpmWaJJcbw3WWS7ptNhqk7dZSVNt6KtuWmvVHxgs6KJK0cg21xVdftB1ZnQZd80DndI5tupTqVqZvfH0otE3Fh3uHXFPH1WBvUr-fqMqw0qqUlUtna3ersh5ikWjro86Ie9P0Xr2bC1f5ovZdGnVDkBrJR4XkALEAh3P5cJBCENHcD8EGCoFcRJL4SUcZZhK6cYYxoE3HEDfkzJhfELuDrm10V-datpNmTdSFQVWSnfNBkQg3IAFnA_o7RHt4lIlm9rkJZp-c1qP_wODRnMf</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1787480833</pqid></control><display><type>article</type><title>Echocardiographic Algorithm for Post-Myocardial Infarction LV Thrombus: A Gatekeeper for Thrombus Evaluation by Delayed Enhancement CMR</title><source>BACON - Elsevier - GLOBAL_SCIENCEDIRECT-OPENACCESS</source><creator>Weinsaft, Jonathan W ; Kim, Jiwon ; Medicherla, Chaitanya B ; Ma, Claudia L ; Codella, Noel C F ; Kukar, Nina ; Alaref, Subhi ; Kim, Raymond J ; Devereux, Richard B</creator><creatorcontrib>Weinsaft, Jonathan W ; Kim, Jiwon ; Medicherla, Chaitanya B ; Ma, Claudia L ; Codella, Noel C F ; Kukar, Nina ; Alaref, Subhi ; Kim, Raymond J ; Devereux, Richard B</creatorcontrib><description>The goal of this study was to determine the prevalence of post-myocardial infarction (MI) left ventricular (LV) thrombus in the current era and to develop an effective algorithm (predicated on echocardiography [echo]) to discern patients warranting further testing for thrombus via delayed enhancement (DE) cardiac magnetic resonance (CMR).
LV thrombus affects post-MI management. DE-CMR provides thrombus tissue characterization and is a well-validated but an impractical screening modality for all patients after an MI.
A same-day echo and CMR were performed according to a tailored protocol, which entailed uniform echo contrast (irrespective of image quality) and dedicated DE-CMR for thrombus tissue characterization.
A total of 201 patients were studied; 8% had thrombus according to DE-CMR. All thrombi were apically located; 94% of thrombi occurred in the context of a left anterior descending (LAD) infarct-related artery. Although patients with thrombus had more prolonged chest pain and larger MI (p ≤ 0.01), only 18% had aneurysm on echo (cine-CMR 24%). Noncontrast (35%) and contrast (64%) echo yielded limited sensitivity for thrombus on DE-CMR. Thrombus was associated with stepwise increments in basal → apical contractile dysfunction on echo and quantitative cine-CMR; the echo-measured apical wall motion score was higher among patients with thrombus (p < 0.001) and paralleled cine-CMR decrements in apical ejection fraction and peak ejection rates (both p < 0.005). Thrombus-associated decrements in apical contractile dysfunction were significant even among patients with LAD infarction (p < 0.05). The echo-based apical wall motion score improved overall performance (area under the curve 0.89 ± 0.44) for thrombus compared with ejection fraction (area under the curve 0.80 ± 0.61; p = 0.01). Apical wall motion partitions would have enabled all patients with LV thrombus to be appropriately referred for DE-CMR testing (100% sensitivity and negative predictive value), while avoiding further testing in more than one-half (56% to 63%) of patients.
LV thrombus remains common, especially after LAD MI, and can occur even in the absence of aneurysm. Although DE-CMR yielded improved overall thrombus detection, apical wall motion on a noncontrast echocardiogram can be an effective stratification tool to identify patients in whom DE-CMR thrombus assessment is most warranted. (Diagnostic Utility of Contrast Echocardiography for Detection of LV Thrombi Post ST Elevation Myocardial Infarction; NCT00539045).</description><identifier>EISSN: 1876-7591</identifier><identifier>DOI: 10.1016/j.jcmg.2015.06.017</identifier><identifier>PMID: 26476503</identifier><language>eng</language><publisher>United States</publisher><subject>Adult ; Aged ; Algorithms ; Contrast Media - administration & dosage ; Echocardiography - methods ; Female ; Heart Aneurysm - diagnostic imaging ; Heart Aneurysm - epidemiology ; Humans ; Image Interpretation, Computer-Assisted - methods ; Magnetic Resonance Imaging, Cine ; Male ; Middle Aged ; Myocardial Infarction - diagnostic imaging ; Myocardial Infarction - epidemiology ; Myocardial Infarction - physiopathology ; Predictive Value of Tests ; Prevalence ; Prognosis ; Prospective Studies ; Referral and Consultation ; Reproducibility of Results ; Stroke Volume ; Thrombosis - diagnostic imaging ; Thrombosis - epidemiology ; Thrombosis - physiopathology ; Unnecessary Procedures ; Ventricular Function, Left</subject><ispartof>JACC. Cardiovascular imaging, 2016-05, Vol.9 (5), p.505-515</ispartof><rights>Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26476503$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Weinsaft, Jonathan W</creatorcontrib><creatorcontrib>Kim, Jiwon</creatorcontrib><creatorcontrib>Medicherla, Chaitanya B</creatorcontrib><creatorcontrib>Ma, Claudia L</creatorcontrib><creatorcontrib>Codella, Noel C F</creatorcontrib><creatorcontrib>Kukar, Nina</creatorcontrib><creatorcontrib>Alaref, Subhi</creatorcontrib><creatorcontrib>Kim, Raymond J</creatorcontrib><creatorcontrib>Devereux, Richard B</creatorcontrib><title>Echocardiographic Algorithm for Post-Myocardial Infarction LV Thrombus: A Gatekeeper for Thrombus Evaluation by Delayed Enhancement CMR</title><title>JACC. Cardiovascular imaging</title><addtitle>JACC Cardiovasc Imaging</addtitle><description>The goal of this study was to determine the prevalence of post-myocardial infarction (MI) left ventricular (LV) thrombus in the current era and to develop an effective algorithm (predicated on echocardiography [echo]) to discern patients warranting further testing for thrombus via delayed enhancement (DE) cardiac magnetic resonance (CMR).
LV thrombus affects post-MI management. DE-CMR provides thrombus tissue characterization and is a well-validated but an impractical screening modality for all patients after an MI.
A same-day echo and CMR were performed according to a tailored protocol, which entailed uniform echo contrast (irrespective of image quality) and dedicated DE-CMR for thrombus tissue characterization.
A total of 201 patients were studied; 8% had thrombus according to DE-CMR. All thrombi were apically located; 94% of thrombi occurred in the context of a left anterior descending (LAD) infarct-related artery. Although patients with thrombus had more prolonged chest pain and larger MI (p ≤ 0.01), only 18% had aneurysm on echo (cine-CMR 24%). Noncontrast (35%) and contrast (64%) echo yielded limited sensitivity for thrombus on DE-CMR. Thrombus was associated with stepwise increments in basal → apical contractile dysfunction on echo and quantitative cine-CMR; the echo-measured apical wall motion score was higher among patients with thrombus (p < 0.001) and paralleled cine-CMR decrements in apical ejection fraction and peak ejection rates (both p < 0.005). Thrombus-associated decrements in apical contractile dysfunction were significant even among patients with LAD infarction (p < 0.05). The echo-based apical wall motion score improved overall performance (area under the curve 0.89 ± 0.44) for thrombus compared with ejection fraction (area under the curve 0.80 ± 0.61; p = 0.01). Apical wall motion partitions would have enabled all patients with LV thrombus to be appropriately referred for DE-CMR testing (100% sensitivity and negative predictive value), while avoiding further testing in more than one-half (56% to 63%) of patients.
LV thrombus remains common, especially after LAD MI, and can occur even in the absence of aneurysm. Although DE-CMR yielded improved overall thrombus detection, apical wall motion on a noncontrast echocardiogram can be an effective stratification tool to identify patients in whom DE-CMR thrombus assessment is most warranted. (Diagnostic Utility of Contrast Echocardiography for Detection of LV Thrombi Post ST Elevation Myocardial Infarction; NCT00539045).</description><subject>Adult</subject><subject>Aged</subject><subject>Algorithms</subject><subject>Contrast Media - administration & dosage</subject><subject>Echocardiography - methods</subject><subject>Female</subject><subject>Heart Aneurysm - diagnostic imaging</subject><subject>Heart Aneurysm - epidemiology</subject><subject>Humans</subject><subject>Image Interpretation, Computer-Assisted - methods</subject><subject>Magnetic Resonance Imaging, Cine</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - diagnostic imaging</subject><subject>Myocardial Infarction - epidemiology</subject><subject>Myocardial Infarction - physiopathology</subject><subject>Predictive Value of Tests</subject><subject>Prevalence</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Referral and Consultation</subject><subject>Reproducibility of Results</subject><subject>Stroke Volume</subject><subject>Thrombosis - diagnostic imaging</subject><subject>Thrombosis - epidemiology</subject><subject>Thrombosis - physiopathology</subject><subject>Unnecessary Procedures</subject><subject>Ventricular Function, Left</subject><issn>1876-7591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNo1kM1Og0AUhScmxtbqC7gws3QDzmWAAXdNxdqkjcZUt81lGAoVGBzAhDfwMXwWn0zSn809i_udk5xDyA0wGxj49zt7J8ut7TDwbObbDMQZGUMgfEt4IYzIZdPsGPOZ74oLMnIG8T3Gx-QnkpmWaJJcbw3WWS7ptNhqk7dZSVNt6KtuWmvVHxgs6KJK0cg21xVdftB1ZnQZd80DndI5tupTqVqZvfH0otE3Fh3uHXFPH1WBvUr-fqMqw0qqUlUtna3ersh5ikWjro86Ie9P0Xr2bC1f5ovZdGnVDkBrJR4XkALEAh3P5cJBCENHcD8EGCoFcRJL4SUcZZhK6cYYxoE3HEDfkzJhfELuDrm10V-datpNmTdSFQVWSnfNBkQg3IAFnA_o7RHt4lIlm9rkJZp-c1qP_wODRnMf</recordid><startdate>201605</startdate><enddate>201605</enddate><creator>Weinsaft, Jonathan W</creator><creator>Kim, Jiwon</creator><creator>Medicherla, Chaitanya B</creator><creator>Ma, Claudia L</creator><creator>Codella, Noel C F</creator><creator>Kukar, Nina</creator><creator>Alaref, Subhi</creator><creator>Kim, Raymond J</creator><creator>Devereux, Richard B</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>201605</creationdate><title>Echocardiographic Algorithm for Post-Myocardial Infarction LV Thrombus: A Gatekeeper for Thrombus Evaluation by Delayed Enhancement CMR</title><author>Weinsaft, Jonathan W ; Kim, Jiwon ; Medicherla, Chaitanya B ; Ma, Claudia L ; Codella, Noel C F ; Kukar, Nina ; Alaref, Subhi ; Kim, Raymond J ; Devereux, Richard B</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p211t-d5371f11b7a254372a19927369117658bdbc75d3ac9fcc4ba9b85a9b1a65ccd03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Algorithms</topic><topic>Contrast Media - administration & dosage</topic><topic>Echocardiography - methods</topic><topic>Female</topic><topic>Heart Aneurysm - diagnostic imaging</topic><topic>Heart Aneurysm - epidemiology</topic><topic>Humans</topic><topic>Image Interpretation, Computer-Assisted - methods</topic><topic>Magnetic Resonance Imaging, Cine</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - diagnostic imaging</topic><topic>Myocardial Infarction - epidemiology</topic><topic>Myocardial Infarction - physiopathology</topic><topic>Predictive Value of Tests</topic><topic>Prevalence</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Referral and Consultation</topic><topic>Reproducibility of Results</topic><topic>Stroke Volume</topic><topic>Thrombosis - diagnostic imaging</topic><topic>Thrombosis - epidemiology</topic><topic>Thrombosis - physiopathology</topic><topic>Unnecessary Procedures</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Weinsaft, Jonathan W</creatorcontrib><creatorcontrib>Kim, Jiwon</creatorcontrib><creatorcontrib>Medicherla, Chaitanya B</creatorcontrib><creatorcontrib>Ma, Claudia L</creatorcontrib><creatorcontrib>Codella, Noel C F</creatorcontrib><creatorcontrib>Kukar, Nina</creatorcontrib><creatorcontrib>Alaref, Subhi</creatorcontrib><creatorcontrib>Kim, Raymond J</creatorcontrib><creatorcontrib>Devereux, Richard B</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>JACC. Cardiovascular imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Weinsaft, Jonathan W</au><au>Kim, Jiwon</au><au>Medicherla, Chaitanya B</au><au>Ma, Claudia L</au><au>Codella, Noel C F</au><au>Kukar, Nina</au><au>Alaref, Subhi</au><au>Kim, Raymond J</au><au>Devereux, Richard B</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Echocardiographic Algorithm for Post-Myocardial Infarction LV Thrombus: A Gatekeeper for Thrombus Evaluation by Delayed Enhancement CMR</atitle><jtitle>JACC. Cardiovascular imaging</jtitle><addtitle>JACC Cardiovasc Imaging</addtitle><date>2016-05</date><risdate>2016</risdate><volume>9</volume><issue>5</issue><spage>505</spage><epage>515</epage><pages>505-515</pages><eissn>1876-7591</eissn><abstract>The goal of this study was to determine the prevalence of post-myocardial infarction (MI) left ventricular (LV) thrombus in the current era and to develop an effective algorithm (predicated on echocardiography [echo]) to discern patients warranting further testing for thrombus via delayed enhancement (DE) cardiac magnetic resonance (CMR).
LV thrombus affects post-MI management. DE-CMR provides thrombus tissue characterization and is a well-validated but an impractical screening modality for all patients after an MI.
A same-day echo and CMR were performed according to a tailored protocol, which entailed uniform echo contrast (irrespective of image quality) and dedicated DE-CMR for thrombus tissue characterization.
A total of 201 patients were studied; 8% had thrombus according to DE-CMR. All thrombi were apically located; 94% of thrombi occurred in the context of a left anterior descending (LAD) infarct-related artery. Although patients with thrombus had more prolonged chest pain and larger MI (p ≤ 0.01), only 18% had aneurysm on echo (cine-CMR 24%). Noncontrast (35%) and contrast (64%) echo yielded limited sensitivity for thrombus on DE-CMR. Thrombus was associated with stepwise increments in basal → apical contractile dysfunction on echo and quantitative cine-CMR; the echo-measured apical wall motion score was higher among patients with thrombus (p < 0.001) and paralleled cine-CMR decrements in apical ejection fraction and peak ejection rates (both p < 0.005). Thrombus-associated decrements in apical contractile dysfunction were significant even among patients with LAD infarction (p < 0.05). The echo-based apical wall motion score improved overall performance (area under the curve 0.89 ± 0.44) for thrombus compared with ejection fraction (area under the curve 0.80 ± 0.61; p = 0.01). Apical wall motion partitions would have enabled all patients with LV thrombus to be appropriately referred for DE-CMR testing (100% sensitivity and negative predictive value), while avoiding further testing in more than one-half (56% to 63%) of patients.
LV thrombus remains common, especially after LAD MI, and can occur even in the absence of aneurysm. Although DE-CMR yielded improved overall thrombus detection, apical wall motion on a noncontrast echocardiogram can be an effective stratification tool to identify patients in whom DE-CMR thrombus assessment is most warranted. (Diagnostic Utility of Contrast Echocardiography for Detection of LV Thrombi Post ST Elevation Myocardial Infarction; NCT00539045).</abstract><cop>United States</cop><pmid>26476503</pmid><doi>10.1016/j.jcmg.2015.06.017</doi><tpages>11</tpages></addata></record> |
| fulltext | fulltext |
| identifier | EISSN: 1876-7591 |
| ispartof | JACC. Cardiovascular imaging, 2016-05, Vol.9 (5), p.505-515 |
| issn | 1876-7591 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1787480833 |
| source | BACON - Elsevier - GLOBAL_SCIENCEDIRECT-OPENACCESS |
| subjects | Adult Aged Algorithms Contrast Media - administration & dosage Echocardiography - methods Female Heart Aneurysm - diagnostic imaging Heart Aneurysm - epidemiology Humans Image Interpretation, Computer-Assisted - methods Magnetic Resonance Imaging, Cine Male Middle Aged Myocardial Infarction - diagnostic imaging Myocardial Infarction - epidemiology Myocardial Infarction - physiopathology Predictive Value of Tests Prevalence Prognosis Prospective Studies Referral and Consultation Reproducibility of Results Stroke Volume Thrombosis - diagnostic imaging Thrombosis - epidemiology Thrombosis - physiopathology Unnecessary Procedures Ventricular Function, Left |
| title | Echocardiographic Algorithm for Post-Myocardial Infarction LV Thrombus: A Gatekeeper for Thrombus Evaluation by Delayed Enhancement CMR |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-27T09%3A18%3A45IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Echocardiographic%20Algorithm%20for%20Post-Myocardial%20Infarction%20LV%20Thrombus:%20A%20Gatekeeper%20for%20Thrombus%20Evaluation%20by%20Delayed%C2%A0Enhancement%20CMR&rft.jtitle=JACC.%20Cardiovascular%20imaging&rft.au=Weinsaft,%20Jonathan%20W&rft.date=2016-05&rft.volume=9&rft.issue=5&rft.spage=505&rft.epage=515&rft.pages=505-515&rft.eissn=1876-7591&rft_id=info:doi/10.1016/j.jcmg.2015.06.017&rft_dat=%3Cproquest_pubme%3E1787480833%3C/proquest_pubme%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-p211t-d5371f11b7a254372a19927369117658bdbc75d3ac9fcc4ba9b85a9b1a65ccd03%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=1787480833&rft_id=info:pmid/26476503&rfr_iscdi=true |