Left ventricular apical thrombus and myocardial viability: A dobutamine stress echocardiographic study

The objective of this article was to determine whether the presence of left ventricular apical thrombus is a marker of nonviable myocardium. Reduced c oronary blood flow secondary to atherosclerosis may result in chronic rever sible left ventricular wall-motion abnormalities. Severe regional abnormali ties also predispose to formation of left ventricular thrombus. The relatio nship between left ventricular apical thrombus and myocardial viability has not been previously described. Eighty patients with coronary artery diseas e and chronic left ventricular dysfunction were studied by dobutamine stres s echocardiography. Left ventricular apical thrombus was identified using e chocardiographic criteria. Wall-motion analysis was performed using a stand ard 16-segment model and ejection fraction was calculated As a result, 48 p atients (60%) had definite or highly suspicious findings for left ventricul ar thrombus (group 1), and 32 patients (40%) had no thrombus (group 2). Gro up 1 had significantly higher composite (54.0 +/- 5.8 vs 43.3 +/- 6.4) and apical (6.0 +/- 2.7 vs 12.4 +/- 3.4) wall-motion scores compared to those i n group 2 (P = 0.01). Thirty-two patients (67%) in group 1 demonstrated no contractile reserve in the apical segments, consistent with lack of viabili ty, versus eight patients (25%) in group 2 (P = 0.0003). The number of viab le apical segments per patient was significantly less in group 1 (0.7 +/- 1 .2) versus group 2 (1.8 +/- 1.3) (P = 0.01). Left ventricular apical thromb us is more likely to be present when, there is absence of myocardial viabil ity in the corresponding segments.