In vivo and in vitro evaluation of left ventricular thrombi by two-dimensional echocardiography. Comparison with cineventriculography.

The purpose of this study was to assess the capability of two-dimensional echocardiography to identify left ventricular thrombi as compared to standard single plane cineventriculography in 284 patients, who underwent both procedures within 24 hours for diagnostic purposes. In order to obtain informations about the degree of thrombus organization and diagnostic accuracy of the echocardiographic technique, two-dimensional echocardiographic examinations were also performed in 31 thrombi from 16 autopsy specimens. In 249 cases the results were negative and in 14 cases positive by both techniques. Seven cases were positive by cineventriculography but negative by 2D-echocardiography. In seven cases the findings were equivocal by two-dimensional echocardiography; three of them were negative, two positive, and two equivocal by cineventriculography. In two cases the results were negative by two-dimensional echocardiography but equivocal by cineventriculography. Finally five cases were diagnosed to have a thrombus but two-dimensional echocardiography but not by cineventriculography. In two patients, positive by two-dimensional echocardiography, who were on anticoagulant therapy, follow-up studies showed the disappearance of left ventricular thrombi. In all of them the thrombi showed tissue characteristics similar to those of fresh thrombi examined in vitro. Two-dimensional echocardiography seems to be more reliable than cineventriculography for assessing the presence, extension, number, and morphology of left ventricular thrombi. In vitro studies suggest that two-dimensional echocardiography cannot visualize small thrombi, that fibrotic areas may simulate a thrombus and that in some cases under or overestimation is possible.