Left ventricular thrombus in ischaemic heart disease: diagnosis, treatment and gaps of knowledge

Author:

Allard Ludovic1,Bernhard Benedikt1ORCID,Windecker Stephan1ORCID,Valgimigli Marco12ORCID,Gräni Christoph1ORCID

Affiliation:

1. Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland

2. Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale and Department of Biomedical Sciences, university of Italian Switzerland, Lugano, Switzerland

Abstract

Abstract Although the management of ischaemic heart disease has markedly improved over the last decades, left ventricular thrombus remains a serious finding in patients with myocardial infarction. Routine diagnostic detection of left ventricular thrombus relies mainly on echocardiography; however, cardiac magnetic resonance has emerged as a method with higher diagnostic accuracy, while cardiac computed tomography angiography represents a valuable alternative modality. To reduce the left ventricular thrombus-associated morbidity and mortality, optimal selection of anticoagulation is warranted after balancing the risk of bleeding. In this review, we will discuss contemporary diagnostic modalities to detect left ventricular thrombus in ischaemic heart disease and summarize evidence on risk stratification and therapy. In addition, we propose a novel diagnosis, follow-up imaging and treatment algorithm. Further, we identify knowledge gaps at different levels to address emerging research questions and to refine the design of future studies aiming to improve the management of patients in this clinical setting.

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Health Policy

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