Prognostic Relevance of Left Ventricular Thrombus Motility: Assessment by Pulsed Wave Tissue Doppler Imaging

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Abstract
Pulsed wave tissue Doppler imaging (PW-TDI) easily detects motion of cardiac structures. Hence, PW-TDI could be of value for
assessing potentially cardioembolic masses. We sought to evaluate the prognostic value of left ventricular (LV) thrombus mobility
assessed by PW-TDI. In 83 consecutive patients with echocardiographically detected LV thrombi, PW-TDI echocardiographic
study was performed. At 1-year follow-up, the composite of major adverse cardiovascular events (MACE) defined as all-cause
mortality plus hospitalizations for stroke/systemic embolism was evaluated. Seventy-two patients (77.1 + 13.1 year/old,
32 males) were studied. All thrombi were located at the LV apex. At 1-year follow-up, 17 cardioembolic events occurred. By
univariable Cox analysis, variables associated with MACE were heart rate (hazard ratio: 1.02, 95% CI: 1.00-1.05; P ¼ .03), thrombi
with mobile free edge (hazard ratio: 3.25, 95% CI: 1.25-8.44; P ¼ .01), hypoechoic thrombi (hazard ratio: 2.86, 95% CI: 1.10-7.42;
P ¼ .03), and mass peak antegrade velocity (Va) 10 cm/s (hazard ratio: 8.79, 95% CI: 2.00-38.5; P ¼ .004). By multivariable
analysis, thrombi with mobile free edge (hazard ratio: 3.54, 95% CI: 1.23-10.2; P ¼ .02), and mass peak Va 10 cm/s (hazard ratio:
7.97, 95% CI: 1.60-39.6; P ¼ .01) retained statistical significance. Mass peak Va 10 cm/s predicted the composite end point with
94% sensitivity and 85% specificity (area under the curve ¼ 0.86). In conclusion, PW-TDI allows objective prognostication of LV
thrombi embolic risk.