Prognostic Relevance of Left Ventricular Thrombus Motility: Assessment by Pulsed Wave Tissue Doppler Imaging

A. Sonaglioni, G.L. Nicolosi, M. Lombardo, C. Anzà, G. Ambrosio

Research output: Contribution to journalArticlepeer-review

Abstract

Pulsed wave tissue Doppler imaging (PW-TDI) easily detects motion of cardiac structures. Hence, PW-TDI could be of value for assessing potentially cardioembolic masses. We sought to evaluate the prognostic value of left ventricular (LV) thrombus mobility assessed by PW-TDI. In 83 consecutive patients with echocardiographically detected LV thrombi, PW-TDI echocardiographic study was performed. At 1-year follow-up, the composite of major adverse cardiovascular events (MACE) defined as all-cause mortality plus hospitalizations for stroke/systemic embolism was evaluated. Seventy-two patients (77.1 ± 13.1 year/old, 32 males) were studied. All thrombi were located at the LV apex. At 1-year follow-up, 17 cardioembolic events occurred. By univariable Cox analysis, variables associated with MACE were heart rate (hazard ratio: 1.02, 95% CI: 1.00-1.05; P =.03), thrombi with mobile free edge (hazard ratio: 3.25, 95% CI: 1.25-8.44; P =.01), hypoechoic thrombi (hazard ratio: 2.86, 95% CI: 1.10-7.42; P =.03), and mass peak antegrade velocity (Va) ≥10 cm/s (hazard ratio: 8.79, 95% CI: 2.00-38.5; P =.004). By multivariable analysis, thrombi with mobile free edge (hazard ratio: 3.54, 95% CI: 1.23-10.2; P =.02), and mass peak Va ≥10 cm/s (hazard ratio: 7.97, 95% CI: 1.60-39.6; P =.01) retained statistical significance. Mass peak Va ≥10 cm/s predicted the composite end point with 94% sensitivity and 85% specificity (area under the curve = 0.86). In conclusion, PW-TDI allows objective prognostication of LV thrombi embolic risk. © The Author(s) 2020.
Original languageEnglish
Pages (from-to)355-363
Number of pages9
JournalAngiology
Volume72
Issue number4
DOIs
Publication statusPublished - 2021

Keywords

  • cardioembolic masses
  • left ventricular thrombi
  • pulsed wave tissue Doppler imaging

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