Two-dimensional echocardiographic appearance of left ventricular thrombi with systemic emboli after myocardial infarction

To test the hypothesis that left ventricular (LV) thrombi that project into the lumen and are mobile are more likely to embolize than those that do not have these characteristics, the 2-dimensional echocardiograms of 16 patients with LV thrombi after myocardial infarction were retrospectively reviewed. Ten had evidence of peripheral embolization and 6 did not. The studies were reviewed in random order by an observer blinded to the clinical data. Each echocardiogram was graded as showing a protruding or nonprotruding thrombus and the presence or absence of increased mobility. The thrombus projected into the lumen on the echocardiograms of 8 of 10 patients who had had emboli and in 0 of 6 who had not. The thrombus had increased mobility in 4 of 10 patients with emboli and 0 of 6 without. Thus, LV thrombi that project into the lumen and have increased mobility are more likely to embolize than those without these characteristics.