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Background The presence of the left ventricle (LV) apical thrombus is one of the most critical complications of anterior myocardial infarction. Due to the high risk of systemic embolization, the determination of LV apical thrombus (LVAT) is essential. Purpose We aimed to compare the Two-Dimensional Echocardiography (2DE), contrast-2DE and Real-time Three-Dimensional Echocardiography (RT-3DE) in the diagnosis of LVAT and determine which imaging modality is superior. Methods The study was designed as a prospective cohort study, and 161 patients were included. Patients with low ejection fraction (&amp;lt;40%) and LV apical wall motion abnormality (severe hypokinetic, akinetic or dyskinetic) were included. 2DE, contrast-2DE, RT-3DE, and Magnetic Resonance Imaging (MRI) were performed to all patients within one month after anterior MI. Results Transthoracic 2DE detected thrombi in 29 patients, contrast 2DE detected thrombi in 33 patients, RT-3DE detected thrombi in 32 patients, and MRI detected thrombi in 28 patients. While MRI is accepted as the gold standard for non-invasive imaging, the specificity of detecting thrombus with 2DE is 90%, and the sensitivity is 57%, contrast-2DE had 82% sensitivity and 92% specificity for the detection of LVAT. The specificity for detecting thrombus with RT-3DE is 93%, and the sensitivity is 85%. Accuracy was 84%, 90% and 92% with 2DE, contrast 2DE and RT-3DE, respectively. Conclusion We found that RT-3DE was more sensitive and more specific than 2DE and contrast-2DE in the diagnosis of LVAT. The diagnostic accuracy of RT-3DE was higher than 2DE and contrast-2DE for LVAT. Funding Acknowledgement Type of funding sources: None.

Impact of Multimodality Imaging on the Diagnosis of Left Ventricular Apical Thrombus in Patients after Anterior MI