Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Can J Cardiol. 2015 Jun;31(6):785-91. doi: 10.1016/j.cjca.2015.01.011. Epub 2015 Jan 24.
Left ventricular (LV) thrombi can occur in the setting of LV dysfunction especially in the acute postmyocardial infarction period. The ideal imaging strategy to detect LV thrombi is currently unknown. The objective of this study was to conduct a systematic review to compare the accuracy of transthoracic echocardiography (TTE) with that of cardiac magnetic resonance (CMR) imaging for the detection of LV thrombi.
OvidMEDLINE, EMBASE, and Cochrane databases were searched for articles published between January 1, 1946 and July 31, 2013. After screening of all potentially relevant abstracts and articles, 7 studies were ultimately selected for this review.
Our results suggest that late gadolinium enhancement CMR imaging is the most accurate modality for the detection of LV thrombi (sensitivity 88%, specificity 99%), followed by cine-CMR imaging (sensitivity 58%-79%, specificity 99%, accuracy 95%, positive predictive value 93%-95%, negative predictive value 95%-96%), contrast TTE (sensitivity 23%-61%, specificity 96%-99%, accuracy 92%, positive predictive value 93%, negative predictive value 91%), and, finally, noncontrast TTE (sensitivity 24%-33%, specificity 94%-95%, accuracy 82%, positive predictive value 57%, negative predictive value 85%). Accuracy of TTE might be improved if a clear clinical indication is provided and with routine use of LV opacifying contrast agents.
Our findings indicate that late gadolinium enhancement CMR imaging is the most accurate sequence in the detection of LV thrombus, and should be favoured when there is a high index of suspicion. When CMR is contraindicated, unavailable, or impractical, our analysis argues for contrast-TTE in patients at high risk for developing LV thrombi.
左心室（LV）血栓可发生于 LV 功能障碍时，尤其是急性心肌梗死后。目前尚不清楚检测 LV 血栓的理想影像学策略。本研究旨在进行系统评价，比较经胸超声心动图（TTE）与心脏磁共振（CMR）成像检测 LV 血栓的准确性。
在 1946 年 1 月 1 日至 2013 年 7 月 31 日期间，检索了 OvidMEDLINE、EMBASE 和 Cochrane 数据库中的文章。在筛选所有潜在相关的摘要和文章后，最终有 7 项研究被纳入本综述。
我们的结果表明，晚期钆增强 CMR 成像在检测 LV 血栓方面是最准确的方法（敏感性 88%，特异性 99%），其次是电影 CMR 成像（敏感性 58%-79%，特异性 99%，准确性 95%，阳性预测值 93%-95%，阴性预测值 95%-96%）、对比 TTE（敏感性 23%-61%，特异性 96%-99%，准确性 92%，阳性预测值 93%，阴性预测值 91%），最后是非对比 TTE（敏感性 24%-33%，特异性 94%-95%，准确性 82%，阳性预测值 57%，阴性预测值 85%）。如果有明确的临床指征，并常规使用 LV 显影对比剂，TTE 的准确性可能会提高。
我们的研究结果表明，晚期钆增强 CMR 成像在检测 LV 血栓方面是最准确的序列，当高度怀疑存在 LV 血栓时，应首选该方法。当 CMR 禁忌、不可用或不切实际时，我们的分析认为在有发生 LV 血栓高风险的患者中，应选择对比增强 TTE。
