Document Type

Article

Department

Internal Medicine (East Africa); Imaging and Diagnostic Radiology (East Africa); Population Health (East Africa)

Abstract

Background Left ventricular thrombus (LVT) is a recognized complication of severe left ventricular (LV) systolic dysfunction. While cardiac magnetic resonance (CMR) Imaging is considered the gold standard due to its high sensitivity and specificity for detecting LVT, its availability remains limited in Sub-Saharan Africa. In contrast, 2D transthoracic echocardiography (TTE) is more accessible and commonly used in clinical practice. This study aimed to determine the incidence of LVT in patients with a left ventricular ejection fraction (LVEF) of less than 35% from any etiology, and to compare the diagnostic accuracy of TTE against CMR for its detection.

Methods This prospective, cross-sectional study was conducted at the Aga Khan University Hospital Nairobi (AKUH, N). The study included patients aged 18 years and above with new onset heart failure symptoms and severely reduced LVEF of ≤ 35%. The study was conducted between January 2021 and December 2023. Patients underwent non-contrast 2D TTE and CMR within a 14-day interval. Diagnostic accuracy of 2D TTE was assessed using sensitivity, specificity, and predictive values.

Results A total of 100 patients were included in the final analysis. The median age of participants was 58.0 years (IQR: 47.0–67.0). The median LVEF was 30% (IQR: 20–33). The median time between 2D echocardiography and cardiac MRI was 10 days (IQR: 1–12). LVT was detected in 11 patients (11%) on CMR. A significantly higher proportion of those with LVT had an ischemic etiology (n = 10, 90.9%) (p <  0.05). Participants with LVT had a lower LVEF (19%, IQR: 14–31) and larger left ventricular internal diameters (IQR 62 mm, IQR: 55–77.5) (p- value <  0.05). Among those with LVT, 73% (n = 8) had it detected by both diagnostic modalities. The 2D TTE’s sensitivity and specificity for detecting LVT were 0.72 and 0.78, respectively, with an excellent negative predictive value of 0.98.

Conclusion 11% of patients were found to have LVT on CMR. Patients with ischemic cardiomyopathy, significantly reduced LVEF, and a dilated LV, were identified as being at the highest risk for developing LVT. 2D TTE showed an excellent negative predictive value in excluding the presence of LVT.

Publication (Name of Journal)

Echo Research & Practice

DOI

https://doi.org/10.1186/s44156-025-00092-1

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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