BACKGROUND Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging is more sensitive than echocardiography for the detection of intracardiac thrombus because of its unique ability to identify thrombus based on tissue characteristics related to avascularity. The long-term prognostic significance of left ventricular (LV) thrombus detected by LGE CMR is unknown. METHODS We performed a matched cohort study of consecutive adult patients with LV thrombus detected by LGE CMR who were matched on the date of CMR, age, and LV ejection fraction to up to 3 patients without LV thrombus. We investigated the long-term incidence of a composite of embolic events: stroke, transient ischemic attack, or extracranial systemic arterial embolism. We also compared outcomes among patients with LV thrombus detected by LGE CMR stratified by whether the LV thrombus was also detected by echocardiography or not. RESULTS Of 157 LV thrombus patients, 155 were matched to 400 non-LV thrombus patients. During a median follow-up of 3.3 years, the cumulative incidence of embolism was significantly higher in LV thrombus patients compared with the matched non-LV thrombus patients (P<0.001), with annualized rates of 3.7% and 0.8% for LV thrombus and matched non-LV thrombus patients, respectively. LV thrombus was the only independent predictor of the composite embolic end point (hazard ratio, 3.99 [95% CI, 1.54-10.35]; P=0.004). The cumulative incidence of embolism was not different in patients with LV thrombus that was also detected by echocardiography versus patients with LV thrombus not detected by echocardiography (P=0.25). CONCLUSIONS Despite contemporary antithrombotic treatment, LV thrombus detected by LGE CMR is associated with a 4-fold higher long-term incidence of embolism compared with matched non-LV thrombus patients. LV thrombus detected by LGE CMR but not by echocardiography is associated with a similar risk of embolism as that detected by both LGE CMR and echocardiography.

中文翻译：

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晚期Ga增强心血管磁共振成像检测左心室血栓后的长期栓塞结局：一项相关队列研究。

背景技术晚期Late增强（LGE）心血管磁共振（CMR）成像比超声心动图对心脏内血栓的检测更为灵敏，这是因为其基于与无血管性相关的组织特征识别血栓的独特能力。由LGE CMR检测到的左心室（LV）血栓的长期预后意义尚不清楚。方法我们进行了一项队列研究，对连续3个月由LGE CMR检测到的成人LV血栓患者进行了匹配研究，这些患者在CMR日期，年龄和LV射血分数上均与3例无LV血栓的患者相匹配。我们调查了一系列栓塞事件的长期发生率：中风，短暂性脑缺血发作或颅外系统性动脉栓塞。我们还比较了是否通过超声心动图检查是否还发现了LV血栓，从而对通过LGE CMR检测到的LV血栓患者的结局进行了比较。结果在157例LV血栓患者中，有155例与400例非LV血栓患者相匹配。在3.3年的中位随访期间，LV血栓患者的栓塞累积发生率显着高于相匹配的非LV血栓患者（P <0.001），LV血栓和LV血栓的年化发生率分别为3.7％和0.8％。匹配非LV血栓患者。LV血栓是复合栓塞终点的唯一独立预测因子（危险比，3.99 [95％CI，1.54-10.35]； P = 0.004）。超声心动图也可检测出左心耳血栓的累积栓塞发生率，超声心动图未检测到左心室血栓的栓塞发生率无差异（P = 0.25）。结论尽管进行了当代抗栓治疗，与匹配的非LV血栓患者相比，通过LGE CMR检测到的LV血栓与长期栓塞发生率高4倍。通过LGE CMR而未通过超声心动图检测到的LV血栓与通过LGE CMR和超声心动图检测到的栓塞风险相似。