A new systematic review and meta-analysis in the #EHJIMP compared transthoracic echocardiography (TTE) with cardiac magnetic resonance (CMR) for the detection of left ventricular thrombus. The analysis included 18 studies involving 3,478 participants. Key findings: ✅ CMR sensitivity: 70.5% ✅ TTE sensitivity: 31.8% ✅ CMR specificity: 99.2% ✅ TTE specificity: 96.3% ✅ CMR AUC: 0.985 ✅ TTE AUC: 0.59 CMR demonstrated a clear diagnostic advantage, particularly for detecting thrombi that may be missed by standard echocardiography, including small or mural thrombi. However, the findings require careful interpretation. Most studies used late gadolinium enhancement CMR as the reference standard, and only five studies provided direct head-to-head comparisons using an independent reference standard. Echocardiographic protocols also varied, and the use of contrast-enhanced TTE was not consistent. The clinical message: ❤️ TTE remains an accessible and valuable first-line test. ❤️ CMR should be considered when TTE is negative but clinical suspicion remains high, when image quality is limited, or in patients at high risk for left ventricular thrombus. ❤️ Contemporary studies using standardized imaging protocols and independent validation are still needed. 🔗 Read the full study: doi.org/10.1093/ehjimp/qyag1… @EHJIMPEiC @VikashJaiswalMD #LeftVentricularThrombus #CardiacMRI #CMR #Echocardiography #TTE #CardiacImaging #MyocardialInfarction #StrokePrevention #Cardiology #ImagingInnovation #CardiovascularMedicine

📄 Ischaemia–reperfusion injury: new insights from quantitative CMR 🔗 DOI: doi.org/10.1093/ehjimp/qyaf1… 🫀 Reperfusion saves myocardium—but it can also cause additional injury. This experimental CMR study provides high-resolution, time-resolved insights into what really happens in the myocardium during ischaemia and early reperfusion. ✨ Study design: 🔹 Swine model of acute MI (LAD occlusion → reperfusion) 🔹 Continuous CMR acquisition at: baseline during ischaemia immediately after reperfusion up to 2–3 hours 🔹 Quantitative T1 & T2 mapping + pixel-wise analysis ✨ Key findings: 📈 During ischaemia: ➡️ Moderate increase in T1 and T2 (+~11%) 👉 reflecting early oedema 📈 After reperfusion: ➡️ Marked increase in T1 and T2 (+~23%) 👉 indicating rapid and significant tissue water accumulation 📊 Critical insight: 👉 The biggest myocardial change happens AFTER reperfusion ➡️ Not during ischaemia ➡️ But immediately after restoring flow 🧠 Three distinct reperfusion patterns identified: 1️⃣ Reperfusion + MVO (microvascular obstruction) 👉 severe injury, largest signal increase 2️⃣ Reperfusion without MVO 👉 less severe but still significant oedema 3️⃣ No effective reperfusion 👉 blunted signal changes 📌 As shown in Figures 2–4 (page 5), each pattern has distinct T1/T2 evolution profiles ⚠️ Key paradigm shift: 👉 Post-reperfusion oedema: ❗ does NOT reflect pre-ischaemic tissue status ❗ does NOT predict final tissue outcome ➡️ Early imaging interpretation may be misleading 🤖 Methodological innovation: ✔ Pixel-wise standardised analysis ✔ Eliminates ROI bias ✔ Enables true spatial and temporal mapping of injury 💡 Clinical implications: 👉 Reperfusion injury is: dynamic, heterogeneous, and not fully captured by traditional imaging timing 👉 Timing of CMR matters: ➡️ early post-reperfusion scans may reflect transient inflammation, not final infarct size 🚨 Bottom line: In acute MI, the most dramatic myocardial changes occur after reperfusion—not during ischaemia—and early oedema does not define final injury. #Cardiology #CMR #MyocardialInfarction #ReperfusionInjury #T1Mapping #T2Mapping #CardiacImaging #PrecisionMedicine #TranslationalResearch 🫀📊