David P Taggart

Jane M Francis

Joseph B Selvanayagam

Ranjit J Arnold

Stefan Neubauer

Tammy J Pegg

Theodoros D Karamitsos

Springer - Publisher Connector

BioMed Central
Journal of Cardiovascular Magnetic 
Resonance
ssOpen AcceMeeting abstract
2005 Detection of 'occult' left ventricular thrombus using 
contrast-enhanced CMR in patients with impaired ventricular 
function undergoing coronary artery bypass surgery
Tammy J Pegg*1, Theodoros D Karamitsos1, Ranjit J Arnold1, 
Jane M Francis1, David P Taggart1, Stefan Neubauer1 and 
Joseph B Selvanayagam2
Address: 1University of Oxford, Oxford, UK and 2Flinders Medical Centre, Adelaide, Australia
* Corresponding author    
Background
Left ventricular (LV) systolic dysfunction is associated
with a 2 to 3 fold increase in the risk of stroke. Although
the pathophysiology underlying this association is com-
plex, the presence of LV thrombus (LVT) is thought to
contribute at least in part to this increased risk. Using
trans-thoracic echocardiography (TTE), the prevalence of
LVT in chronic heart failure is reported to be 20–40%.
More recently contrast enhanced cardiac magnetic reso-
nance imaging (CE-CMR) has emerged as an important
non-invasive tool for the assessment of heart failure and
has the capability to diagnose LVT with greater ease than
TTE.
Aims
(1) To examine the prevalence of LVT as detected by CE-
CMR in a consecutive series of patients with chronic LV
dysfunction referred for coronary artery bypass surgery
(CABG). (2) To compare the rates of detection of LVT
between CMR and TTE/ventriculography in this popula-
tion of patients.
Methods
44 patients with impaired ventricular function (EF meas-
ured by CMR < 50%) scheduled for isolated elective CABG
were recruited, and underwent conventional LV assess-
ment (TTE and LV angiography) as part of the clinical pre-
operative assessment, and CMR as part of a research pro-
tocol. All CMR examinations were performed on a 1.5
Tesla Siemens Sonata scanner, CE-CMR images were
acquired in three long axis planes using steady state free
precession imaging (flip angle 60° TE/TR 1.6/700 TI 450
ms or ultra fast gradient echo imaging (flip angle 25° TE/
TR 4.3/750 TI 450 ms) following a bolus injection of
Gadodiamide (Omniscan 0.1.mmol/kg body weight).
The CMR images were analysed for the presence of LVT by
two blinded observers working in consensus. LVT was
defined as a filling defect characteristically present at the
apex, or associated with an area of wall motion abnormal-
ity that was seen in 2 image planes. Artefact was character-
ised by a filling defect present in only the read out
direction (chemical shift), was seen within the wall of the
myocardium (no-reflow phenomenon) or was visualised
in only one plane.
Results
The overall mean age was 66 ± 8 years and 93% were
male. Eight out of 44 patients (18%) had LVT identified
by CE-CMR. Patients with LVT tended to have a lower
ejection fraction and increased LV volumes, however none
of these comparisons were statistically significant, Table 1.
Patients with LVT were significantly younger (61 ± 10
years) than patients in whom thrombus was not identi-
fied (67 ± 7 years) p = 0.03, Table 1. Logistic regression
from 11th Annual SCMR Scientific Sessions
Los Angeles, CA, USA. 1–3 February 2008
Published: 22 October 2008
Journal of Cardiovascular Magnetic Resonance 2008, 10(Suppl 1):A274 doi:10.1186/1532-429X-10-S1-A274
<supplement> <title> <p>Abstracts of the 11<sup>th </sup>Annual SCMR Scientific Sessions - 2008</p> </title> <note>Meeting abstracts – A single PDF containing all abstracts in this Supplement is available <a href="http://www.biomedcentral.com/content/files/pdf/1532-429X-10-s1-full.pdf">here</a>.</note> <url>http://www.biomedcentral.com/content/pdf/1532-429X-10-S1-info.pdf</url> </supplement>
This abstract is available from: http://jcmr-online.com/content/10/S1/A274
© 2008 Pegg et al; licensee BioMed Central Ltd. Page 1 of 3
(page number not for citation purposes)
Journal of Cardiovascular Magnetic Resonance 2008, 10(Suppl 1):A274 http://jcmr-online.com/content/10/S1/A274analysis demonstrated age to be the only predictor for
LVT, with younger age indicating a higher risk, Table 2.
Conventional imaging identified the presence of LVT in
only 3 patients, 2 by LV angiography and 1 by TTE. Two
patients with LVT identified by CE-CMR had sustained a
stroke within 6 months of their CMR scan, Patients A and
C, Figure 1.
Conclusion
LVT is difficult to diagnose by conventional imaging tech-
niques and CE-CMR may have a role in the pre-operative
assessment of this group, both for viability assessment
and LVT detection. LVT was more likely to be present in
younger patients presenting with heart failure, and factors
that are associated with premature ischemic heart disease
may also influence the prevalence of LVT.
Table 1: Patient demographics of patients with and without 
LVT.
LVT + LVT -
Age (years) 61 ± 10 67 ± 7*
Male 100 (8/8) 92 (33/36)
Smoking 25 (2/8) 8 (6/36)
Diabetes 38 (3/8) 33 (12/36)
Q waves 50 (4/8) 56 (20/36)
LVEF (%) 37 ± 14 39 ± 11
LVEDVI (ml.m-2) 136 ± 40 114 ± 31
LVESVI (ml.m-2) 89 ± 41 72 ± 31
DHE (grams) 31 ± 5 25 ± 13
Warfarin 25 (2/8) 6 (2/36)
ACE inhibitor 88 (7/8) 94 (34/36)
EURO Score 7.9 ± 4.6 10.3 ± 9
Demographics expressed as percentage (absolute values) or mean ± 
SD for continuous variables. LVEF, Left ventricular ejection fraction; 
LVEDVI, left ventricular end-diastolic volume index; LVESVI, left 
ventricular end-systolic volume index; DHE, delayed 
hyperenhancement; ACE, angiotensin converting enzyme. *p = 0.03.
Table 2: Forward stepwise logistic regression analysis for the risk 
factors associated with the presence of LV thrombus.
95% CI for exp b
B (SE) Lower exp B Upper
Included
Constant 5.8 (3.5)* 2510
Age -0.12 (0.06)* 0.760 0.892 0.978
*p < 0.05, Nagelkerke R2 = 0.169, Cox & Snell R2 = 0.104, -2 Log 
likelihood = 36.917.Page 2 of 3
(page number not for citation purposes)
Publish with BioMed Central   and  every 
scientist can read your work free of charge
"BioMed Central will be the most significant development for 
disseminating the results of biomedical research in our lifetime."
Sir Paul Nurse, Cancer Research UK
Your research papers will be:
available free of charge to the entire biomedical community
peer reviewed and published immediately upon acceptance
cited in PubMed and archived on PubMed Central 
yours — you keep the copyright
Submit your manuscript here:
http://www.biomedcentral.com/info/publishing_adv.asp
BioMedcentral
Journal of Cardiovascular Magnetic Resonance 2008, 10(Suppl 1):A274 http://jcmr-online.com/content/10/S1/A274
Page 3 of 3
(page number not for citation purposes)
Patient A had thrombus using ultra fast gradient echo sequence early after IV Gd-DTPA administration, LVT was present at the apexFigure 1
Patient A had thrombus using ultra fast gradient echo sequence early after IV Gd-DTPA administration, LVT was present at the 
apex. This patient sustained a stroke prior to CABG. Patient B had a small apical aneurysm, thrombus was visualised in only the 
LVOT plane on the steady state free precession imaging. As image quality on the early post gad image was impaired by respira-
tory artefact, the thrombus was confirmed using the delayed hyperenhancement sequence (ultrafast gradient echo TE/TR 4.3/
750 TI 270–350). Patient B had LVT diagnosed on conventional imaging (LV angiography). Patient C had thrombus detected by 
post contrast image steady state free precession imaging, which demonstrated LVT at the apex, this patient had sustained a 
stroke 4 months prior to CABG.


2005 Detection of 'occult' left ventricular thrombus using contrast-enhanced CMR in patients with impaired ventricular function undergoing coronary artery bypass surgery

file:///data/core-remote/dit/data/Springer-OA/pdf/e13/aHR0cDovL2xpbmsuc3ByaW5nZXIuY29tLzEwLjExODYvMTUzMi00MjlYLTEwLVMxLUEyNzQucGRm.pdf

2005 Detection of 'occult' left ventricular thrombus using contrast-enhanced CMR in patients with impaired ventricular function undergoing coronary artery bypass surgery

Abstract

Similar works

Full text

Available Versions

Springer - Publisher Connector

Springer - Publisher Connector