Role of new echocardiographic technologies
Over the past decade, we have witnessed a development in the
armamentarium of echocardiographic technologies capable of providing
even more detailed information about LVT. Many of these features allow
an integrative approach, as they combine the unique strengths of the
single technologic component to achieve unprecedented improvement in our
ability to diagnose LVT by TTE. Real-time three-dimensional
echocardiography (RT3DE) provides an unlimited (“panoramic”) number of
cutting planes in all directions through a single full volume data set
(Fig.3). Therefore, cropping and rotating the volumetric data set allow
to obtain the perspective that best visualizes a LVT and its attachment
to the LV wall. The chance to re-align the tomographic planes obtained
from a RT3DE dataset reduces the risk of missing small apical thrombi
due to the foreshortening of apical views with two-dimensional
TTE.23, 24 However, RT3DE does not allow to
differentiate between LVT and myocardium nor to assess the changes in
thrombi structure, as it is known that with RT3DE the different shades
of blue/brown color give a visual perception of the depth of different
structures rather than their texture.
The advent of ultrasound contrast agents, providing the opacification
within the cardiac chambers to demonstrate the avascular “filling
defect” appearance of an intracardiac LVT, has been
critical.25 Indeed, it is now proven that the use of
ultrasound contrast agents greatly improves the diagnostic accuracy of
TTE from 82% to 92% when compared to CE-CMR.14