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Smoker, 80 years old, suspected heart failure : Case 3

Contrast Echocardiography for assessment of LV structure and function

Patient Description

80 year old male
Smoker
Admitted due to suspected Heart Failure November 2007
Echo revealed severely decreased systolic LV function, EF 15%
Normal angiogram (Non-ischemic dilated cardiomyopathy)
Numerous runs of non-sustained VT
Scheduled for ICD
Medication led to a clinical improvement; NYHA IIIb, II, No remaining VT episodes during mobilisation

Echocardiography 4th Dec to see whether EF improved > 35 %

Siebilink et al. Coron Artery Dis 2009;20:462–466

Echocardiography

A slight improvement of EF, still ICD indication BUT…

A strange thickening of the apical myocardium
SonoVue bolus was given for clarity…

Apical layer of mural thrombus which is not perfused in contrast to the clear myocardial perfusion seen using low MI imaging (MI 0.1)

991 post MI pts
156 LV contrast due to suspected LV thrombust

Contrast Echo Box : Atlas

Contrast Echo Box : Atlas

Contrast Echo Box : Atlas

Note: Apical thrombus cannot be reliably diagnosed without contrast in many cases