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Improved detection of left ventricular thrombi and spontaneous echocontrast by tissue harmonic imaging in patients with myocardial infarction.

Mele D, Soukhomovskaia O, Pacchioni E, Merli E, Avigni N, Federici L, Levine RA, Ferrari R

Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, and Centro di Fisiopatologia Cardiovascolare Salvatore Maugeri, Foundation IRCCS, Ferrara, Italy. donatomele@libero.it <donatomele@libero.it>

BACKGROUND: Tissue harmonic imaging (THI) reduces near-field and side-lobe artifacts. This could improve recognition of cardiac masses, including thrombi and spontaneous echocontrast (SEC), a known thromboembolic risk factor. OBJECTIVES: We tested the hypothesis that THI improves detection of left ventricular (LV) thrombi and SEC compared with transthoracic fundamental imaging in patients with recent myocardial infarction. METHODS: In all, 118 consecutive patients with recent myocardial infarction were studied at predischarge. The echocardiographic examination was performed in both fundamental imaging and THI modality and evaluated by 3 skilled and 3 nonexperienced observers for recognition of LV thrombosis and SEC. RESULTS: THI increased LV thrombi diagnosis by 25% by skilled observers and by 50% by nonexperienced readers, reducing the number of false-positive diagnoses by 67%. Also, compared with fundamental imaging, THI improved recognition of LV SEC by both experienced and nonexperienced observers by 56% and 62%, respectively. CONCLUSIONS: The improved recognition of LV thrombosis and SEC by THI in patients with myocardial infarction is clinically relevant allowing appropriate treatment and prognostic stratification. Therefore, routine use of THI should be recommended when studying such patients in clinical practice.

Published 13 November 2006 in J Am Soc Echocardiogr, 19(11): 1373-81.
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