Circulation, Vol 66, 156-166, Copyright © 1982 by American Heart Association
JR Stratton, GW Lighty Jr, AS Pearlman and JL Ritchie
To define the sensitivity, specificity and predictive accuracy of two-
dimensional echocardiographic detection of left ventricular thrombus, the
echocardiograms of 78 patients who had independent proof of the presence or
absence of a left ventricular thrombus were interpreted without knowledge
of any clinical data. The presence of thrombus was established by autopsy
in four patients, by aneurysmectomy in three, and by indium-111 platelet
imaging in 15; the absence of thrombus was proved by autopsy in 55 patients
and by aneurysmectomy in one patient. The characteristics of true-positive
and false-positive echocardiograms, interobserver variability, and clinical
features associated with proved thrombus were also defined. The
echocardiogram was positive for thrombus in 22 patients, equivocal in seven
and negative in 49. For detection of thrombus, a positive or equivocal
echocardiogram had a sensitivity of 95% (21 of 22), a specificity of 86%
(48 of 56), and a predictive value of 72% (21 of 29); the predictive value
of a negative study was 98% (48 of 49). Considering positive and equivocal
studies separately, the predictive value of a positive study was 86% (19 of
22), while that of an equivocal study was only 29% (two of seven). Compared
with patients who had no thrombus, patients with proved thrombus had a
higher prevalence of electrocardiographic transmural anterior infarction
(86% vs 13%), left ventricular aneurysm (73% vs 5%), and clinical systemic
emboli (36% vs 7%) (all p less than 0.05). These clinical features help to
identify a subset of patients most likely to have left ventricular thrombi
who may benefit from echocardiography. Two-dimensional echocardiography is
highly sensitive in detecting left ventricular thrombus, but false-
positive studies are relatively common. Several echocardiographic criteria
derived from analysis of the true and false positives in this study may
help minimize diagnostic errors.
ARTICLES
Detection of left ventricular thrombus by two-dimensional echocardiography: sensitivity, specificity, and causes of uncertainty
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