Cardiac Magnetic Resonance Imaging versus Transthoracic Echocardiography for Detecting Left Ventricular Thrombus in Patients with Reduced Ejection Fraction: A Retrospective Observational Study

Abstract

Objectives: To compare the diagnostic performance of transthoracic echocardiography and cardiac magnetic resonance imaging for the detection of left ventricular thrombus in patients with reduced ejection fraction. Methodology: This retrospective observational study included 59 patients with LVEF ≤40% who underwent both TTE and CMR between January 2022 and December 2023 at a tertiary cardiac center. CMR was used as the reference standard for LVT detection. Diagnostic accuracy parameters, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated for TTE. Results: Transthoracic echocardiography detected left ventricular thrombus in 3.4% of patients, whereas CMR identified thrombus in 76.3%. TTE demonstrated very low sensitivity (4.4%) but high specificity (100%). In contrast, CMR achieved 100% sensitivity, specificity, PPV, and NPV. The study population had a high prevalence of diabetes, obesity, and hypertension. Conclusion: Cardiac magnetic resonance imaging significantly outperforms transthoracic echocardiography in detecting left ventricular thrombus in patients with reduced ejection fraction. While TTE remains a valuable screening tool due to its accessibility, its low sensitivity limits its reliability for excluding LVT. In high-risk patients, CMR should be considered to ensure accurate diagnosis and optimal clinical management.