Dataset Information

Post-ischaemic exuberant left ventricular mass: thrombus vs. tumour-case report.

ABSTRACT:

Background

We present a case that illustrates the diagnostic challenge of differentiating thrombus from tumour when confronted with a large left ventricular (LV) cardiac mass.

Case summary

A 43-year-old Caucasian woman polysubstance-abuser presented to a regional hospital with an ST-elevation myocardial infarction and underwent aspiration-thrombectomy and successful circumflex artery bare metal stenting. She was noted to have an exuberant LV mass on transthoracic echocardiogram the following day and transferred to our care. Transthoracic echocardiogram, transoesophageal echocardiogram, and cardiac magnetic resonance imaging were performed in an attempt to characterize the mass with conflicting findings for either thrombus or tumour. The mass was surgically excised and final pathology indicated a fibrin-rich thrombus.

Discussion

The association of the mass with an infarcted area of the left ventricle supported the diagnosis of thrombus. However, due to the size and some imaging features a myxoma could not be completely ruled out. Atypical presentations of thrombus can be difficult to differentiate from cardiac tumours.

SUBMITTER: Viscuse PV

PROVIDER: S-EPMC6177049 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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Publications

Post-ischaemic exuberant left ventricular mass: thrombus vs. tumour-case report.

Viscuse Paul V PV Bartlett David J DJ Foley Thomas A TA Michelena Hector I HI

European heart journal. Case reports 20180711 3

<h4>Background</h4>We present a case that illustrates the diagnostic challenge of differentiating thrombus from tumour when confronted with a large left ventricular (LV) cardiac mass.<h4>Case summary</h4>A 43-year-old Caucasian woman polysubstance-abuser presented to a regional hospital with an ST-elevation myocardial infarction and underwent aspiration-thrombectomy and successful circumflex artery bare metal stenting. She was noted to have an exuberant LV mass on transthoracic echocardiogram th ...[more]

PMID: 31020155

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Project description:Left ventricular thrombus (LVT) is a serious complication of acute myocardial infarction (MI) and also non-ischemic cardiomyopathies. We performed a narrative literature review, manual-search of reference lists of included articles and relevant reviews. Our literature review indicates that the incidence of LVT following acute MI has decreased, probably due to improvement in patient care as a result of better and earlier reperfusion techniques. Predictors of LVT include anterior MI, involvement of left ventricular (LV) apex (regardless of the coronary territory affected), LV akinesis or dyskinesis, reduced LV ejection fraction (LVEF), severe diastolic dysfunction and large infarct size. LVT is associated with increased risk of systemic embolism, stroke, cardiovascular events and death, and there is evidence that anticoagulant therapy for at least 3 months can reduce the risk of these events. Cardiac magnetic resonance (CMR) has the highest diagnostic accuracy for LVT, followed by echocardiography with the use of echocardiographic contrast agents (ECAs). Although current guidelines suggest use of vitamin K antagonist (VKA) for a minimum of 3 to 6 months, there is growing evidence of the benefits of direct acting oral anticoagulants in treatment of LVT. Embolic events appear to occur even after resolution of LVT suggesting that anticoagulant therapy needs to be considered for a longer period in some cases. Recommendations for the use of triple therapy in the presence of the LVT are mostly based on extrapolation from outcome data in patients with atrial fibrillation (AF) and MI. We conclude that the presence of LVT is more likely in patients with anterior ST-segment elevation MI (STEMI) (involving the apex) and reduced ejection fraction (EF). LVT should be considered a marker of increased long-term thrombotic risk that may persist even after thrombus resolution. Ongoing clinical trials are expected to elucidate the best management strategies for patients with LVT.

Project description:Background and objectiveLeft ventricular thrombus (LVT) formation in patients with acute myocardial infarction (AMI) or cardiomyopathies is not uncommon. The optimal oral anticoagulation therapy for resolving LVT has been under intense debate. Vitamin K antagonists (VKAs) remain the anticoagulant of choice for this condition, according to practice guidelines. Evidence supporting the use of direct oral anticoagulants (DOACs) in the management of LVT continues to grow. We performed a systematic review and meta-analysis to compare the efficacy and safety of DOACs versus VKAs.MethodsA comprehensive literature search was carried out in PubMed, Cochrane Library, Web of Science, Embase, and Scopus databases in July 2023. The efficacy outcomes of this study were thrombus resolution, ischemic stroke, systemic embolism, stroke/systemic embolism, all-cause mortality, and adverse cardiovascular events. The safety outcomes were any bleeding, major bleeding, and intracranial hemorrhage. A total of twenty-seven eligible studies were included in the meta-analysis. Data were analyzed utilizing Stata software version 15.1.ResultsThere was no significant difference between DOACs and VKAs with regard to LVT resolution (RR = 1.00, 95% CI 0.95-1.05, P = 0.99). In the overall analysis, DOACs significantly reduced the risk of stroke (RR = 0.74, 95% CI 0.57-0.96, P = 0.021), all-cause mortality (RR = 0.70, 95% CI 0.57-0.86, P = 0.001), any bleeding (RR = 0.75, 95% CI 0.61-0.92, P = 0.006) and major bleeding (RR = 0.67, 95% CI 0.52-0.85, P = 0.001) when compared to VKAs. Meanwhile, in the sub-analysis examining randomized controlled trials (RCTs), the aforementioned outcomes no longer differed significantly between the DOACs and VKAs groups. The incidences of systemic embolism (RR = 0.81, 95% CI 0.54-1.22, P = 0.32), stroke/systemic embolism (RR = 0.85, 95% CI 0.72-1.00, P = 0.056), intracranial hemorrhage (RR = 0.59, 95% CI 0.23-1.54, P = 0.28), and adverse cardiovascular events (RR = 0.99, 95% CI 0.63-1.56, P = 0.92) were comparable between the DOACs and VKAs groups. A subgroup analysis showed that patients treated with rivaroxaban had a significantly lower risk of stroke (RR = 0.24, 95% CI 0.08-0.72, P = 0.011) than those in the VKAs group.ConclusionWith non-inferior efficacy and superior safety, DOACs are promising therapeutic alternatives to VKAs in the treatment of LVT. Further robust investigations are warranted to confirm our findings.

Dataset Information

Post-ischaemic exuberant left ventricular mass: thrombus vs. tumour-case report.

Background

Case summary

Discussion

Publications

Post-ischaemic exuberant left ventricular mass: thrombus vs. tumour-case report.

Similar Datasets

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