Left Ventricular Thrombus among patients undergoing Transthoracic Echocardiography in a north - western Nigerian tertiary health institution.

Authors

  • H. Saidu
  • M. S. Mijinyawa
  • M. Y. Ahmad
  • M. U. Sani

Keywords:

Prevalence, Aetiology, Left Ventricular Thrombus, Echocardiography

Abstract

Objective: Left Ventricular Thrombus (LVT) is a well recognized complication of various cardiac conditions, particularly following an acute anterior myocardial infarction and in those with systolic congestive heart failure. Transthoracic echocardiography (TTE) remains the most common imaging modality to make the diagnosis of LVT. This study aims to determine the prevalence and aetiology of LVT among patients undergoing echocardiography in our centre.

Methods: We reviewed echocardiographic reports and case notes of 1012 patients aged ≥ 15 years, who had echocardiogram between September 2011 and August 2014 (3 years). The reports and case notes were reviewed for demographic parameters, indications for the procedure, main echocardiographic diagnoses, presence of LVT and the presence of associated thrombo-embolic complication. Mean±SD were derived for continuous variables and comparison was made using students't- test.

Results: The mean age of the 1,012 individuals studied was 41.28±16.25 years. There were 330 males and 682 females. 861(85.1%) had abnormal echocardiography out of which 79 (9.2%) had LVT. The highest prevalence of 61(77.2%) was observed in patients with Peripartum cardiomyopathy (PPCM), followed by Dilated cardiomyopathy (DCM) 10 (12.7%). Hypertensive heart disease (HHD) accounted for 4 (5.1%) while Rheumatic heart disease (RHD) and Myocardial infarction (MI) accounted for 2 (2.5%) each.

Conclusion: LVT is common among patients undergoing echocardiography with PPCM being the most common underlying aetiology, followed by DCM.

References

Asinger RW, Mikell FL, Elsperger J, Hodges M. Incidence of left ventricular thrombus after acute transmural myocardial infarction. Serial evaluation by two – dimensional

echocardiography. N Engl J Med 1981; 305:295 – 302.

Kalra A, Jang IK. Prevalence of early left ventricular thrombus after primary coronary intervention for acute myocardial. J Thromb Thrombolysis 2000; 10: 133 – 136.

Greaves SC, Zhi G, Lee RT. Incidence and natural history of left ventricular thrombus following anterior wall myocardial infarction. Am J Cardiol 1997; 80: 442 – 448.

Nayak D, Aronow WS, Sukhija R, Mc Clung JA, Monsen CE, Belkin RN. Comparison of frequency of left ventricular thrombi in patients with anterior wall versus non – anterior wall acute myocardial infarction treated with antithrombotic and antiplatelet therapy with or without coronary revascularization. Am J Cardiol 2004; 93: 1529 – 1530.

Ciaccheri M, Castelli G, Cacchi F. Lack of correlation between intracavitatory thrombosis detected by cross sectional echocardiography and systemic emboli in patients with dilated cardiomyopathy. Br Heart J 1989;62: 26 – 29.

Visser CA, Kan G, David GK, Lie KL, Durrer D. Two dimensional echocardiography in the diagnosis of left ventricular thrombus. A prospective study of 67 patients with anatomic validation. Chest 1983; 83: 228 – 232.

Cacciapuoti F, Varrichio M, D'Avino M, Gentile S, Lama D, Cotrufo M et al. Post necrotic endoventricular thrombosis. Comparative evaluation of the diagnostic reliability of two – dimensional echocardiography and cine ventriculography .G Ital Cardiol 1986; 16: 344 – 349.

Viatkus PT, Barnathan ES. Embolic potential, prevention and management of mural thrombus complicating anterior myocardial infarction: a meta analysis. J Am Coll Cardiol 1993; 22: 1004 – 1009.

Johannessen KA, Nordrenhaug JE, Von der Lippe G, Vollset SE. Risk factors for embolization in patients with left ventricular thrombi and acute myocardial infarction. Br Heart J 1988; 60: 1988 – 90.

Jugdutt BI, Sivaram CA, Wortman C, Trudell C, Penner P. Prospective two – dimensional echocardiographic evaluation of left ventricular thrombus and embolism after acte myocardial infarction. J Am Coll Cardiol 1989; 13: 554 – 564.

Sahn DJ, De Maria A, Kisslo J, Weyman A. The committee on M – mode standardization of the

American Society of Echocardiography. Recommendation regarding quantitation in M – mode echocardiography measurements. Circulation 1978; 58:1072 – 1083.

Quininones MA, Otto CM, Stoddard M, WA Zoghbi, SF Nagueh. Reccommendation for quantification of Doppler Quatification Task force of the Nomenclature and Standards Committee of the American Society of echocardiography. J Am Soc Echocardiogr 2002; 15(2):167 – 184.

Ganau A, Devereux RB, Roman MJ, G de

Simone, Pickering TG, Saba PS,et al: Pattern of left ventricular hypertrophy and geometry in essential hyprtension. J Am Cardiol 1992, 19: 1550 – 1558.

Billingsley IM and Leong – Poi H,” Left ventricular thrombus: diagnosis, prevention, and management.” Cardiology Rounds vol. X, no. 7, 2005.

Armstrong WF and Ryan T. “Masses, tumors and source of embolism.” In Feigenbaum's Echocardiography, pp. Lippincott Williams& Wilkins, Philadelphia,Pa, USA, 7th edition, 2010.

Cardiomyopathies : Report of a WHO Expert Committee. World Health Organ Tech Rep Ser 1984; 697: 7 – 64.

Sliwa K, Hilfiker – Kleino D, Petrie MC.

Current state of knowledge on aetiology, diagnosis, management and therapy of peripartum cardiomyopathy: a Position statement from the Heart failure Associations of the European Society of Cardiology Working

Group on peripartum cardiomyopathy.”

European Journal of Heart failure 2010,8: 767 – 778.

Ganau A, Devereux RB, Roman MJ, G de

Simone, Pickering TG, Saba PS, et al. Pattern of left ventricular hypertrophy ang geometry in essential hyprtension. J Am Cardiol 1992, 19: 1550 – 1558.

Remenyi B, Wison N, Steer A, Ferreira B, Kado J, Kumar K, et al. World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease – an evidence – based guideline. Nature Reviews Cardiology 2012; 9: 297 – 309.

Armstrong WF, Ryan T. 'Echocardiography and coronary heart disease' in Feigenbarun's Echocardiography, PP 427 – 472, Lippincott Williams and Williams, Philadelphia, Pa, USA, 7th edition, 2010.

Karaye KM, Sani MU. Factors associated with poor prognosis among patients admitted with heart failure in a Nigerian tertiary medical center : a cross sectional study. BMC Cardiovascular Disorders, 2008; 6: 16.

Talle MA, Buba F, Anjorin CO. Prevalence and Aetiology of Left Ventricular Thrombus in patients undergoing Transthoracic Echocardiography at the University of Maiduguri Teaching Hospital. Advances in Medicine doi: 10.1155/ 2014/ 731936.

Isezuo SA, Abubakar SA. Epidemiologic profile of peripartum cardiomyopathy in a tertiary care hospital. Ethnicity and Disease 2007; 17:228 – 233.

Nayak D, Aronow WS, Sukhija R, McClung JA, Monsen CE, Belkin RN.Comparison of frequency of left ventricular thrombi in patients with anterior wall versus non- anterior wall myocardial infarction treated with antithrombotic and antiplatelet therapy with or with out coronary revascularization. Am J Cardiol.2004; 93:1529 – 1530.

Ciachei M, Castelli G, Cecchi F. Lack of correlation between intracavitatory thrombus detected by conventional echocardiographyand systemic emboli in patients with dilated cardiomyopathy. Br Heart J 1989; 62:26 – 29.

Gottdiener JS, Gay JA, Van Voohees L, Di Bianco R, Fletcher RD. Frequency and embolic potential of left ventricular thrombus in dilated cardiomyopathy: assessment by 2- dimensional echocardiography. Am J Cardiol 1983; 52: 1281 – 1285.

Loh E, Sutton C, Wun C. Ventricular dysfunction and the risk of stroke after myocardial infarction. New England Journal of Medicine 1997; 336:251 – 257.

Walter BF, Gridder L, Rohr TM, Mc Laughin T, Taliercio CP, Felters J. Intracardiac thrombi:

Frequency, location, aetiology and

complication; a morphologic review, part IV, Clinical cardiology. 1995; 11:669 – 674.

Sani MU, Adamu B, Mijinyawa, Abdu A,

Maiyaki MB, Borodo MM et al. Ischaemic heart disease in Aminu Kano Teaching Hospital Kano, Kano, Nigeria: A 5 year review. Nigerian Journal of Medicine. 2006; 15: 128 – 131.

Saidu H, Sani MU, Mijnyawa MS, Yakasai AM. Echocardiographic pattern of heart diseases in a North western Nigerian tertiary health institution Nigerian Journal of basic and clinical health sciences. 2005; 12: 39 – 42.

Delewi R, Zijlstra F, Piek JJ. Left ventricular thrombus formation after acute myocardial infarction. Heart. 2012; 98: 1743 – 1749.

Vandvik PO, Lincoff JM, Gore JM, Gutterman DD, Sonnenberg FA, Alonso – Coello P, et al. Primary and secondary prevention of Cardiovascular Disease. Antithrombotic

Therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians. Evidence based Clinical Practice Guidelines. Chest 2002; 141: e637s – e668s.

Downloads

Published

2023-10-07

How to Cite

Saidu, H., Mijinyawa , M. S., Ahmad , M. Y., & Sani , M. U. (2023). Left Ventricular Thrombus among patients undergoing Transthoracic Echocardiography in a north - western Nigerian tertiary health institution. Research Journal of Health Sciences, 4(1), 1–8. Retrieved from https://rjhs.org/index.php/home/article/view/133