{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T09:41:40Z","timestamp":1792230100678,"version":"4.4.0"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:00:00Z","timestamp":1789776000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Left ventricular thrombus (LVT) is a significant complication of myocardial infarction, associated with increased morbidity and mortality because of the risk of systemic embolization and stroke. Early detection of LVT is therefore important for the timely initiation of anticoagulation therapy. This systematic review and meta-analysis compared the diagnostic accuracy of cardiac magnetic resonance (CMR) with transthoracic echocardiography (TTE) for the detection of LVT. Following PRISMA guidelines, PubMed, Cochrane, CNKI, Scopus, LILACS, Web of Science, Google Scholar, EMBASE, and CINAHL were searched. Random-effects meta-analyses were performed in R (v3.4.3), with pooled proportions or area under the curve (AUC) values reported alongside 95% confidence intervals, and heterogeneity assessed using the I\u00b2 statistic. Eighteen studies involving 3478 participants met the inclusion criteria. Most studies contributed to the primary analysis of TTE performance using CMR as the reference standard, while only five studies allowed direct head-to-head comparison using an independent reference standard. In the head-to-head analysis, CMR demonstrated higher sensitivity (70.5%, 95% CI: 0.554-0.822) and specificity (99.2%, 95% CI: 0.983-0.997) for detecting LVT compared with TTE, which showed a sensitivity of 31.8% (95% CI: 0.252-0.391) and specificity of 96.3% (95% CI: 0.929-0.981). The AUC for CMR was 0.985 compared with 0.59 for TTE. Heterogeneity was significant for TTE (I\u00b2 = 75.8%) but low for CMR (I\u00b2 = 0.0%). Funnel-plot assessment suggested a low likelihood of publication bias. These findings suggest that CMR may provide a diagnostic advantage over TTE for LVT detection, particularly in high-risk patients or when TTE findings are negative or inconclusive. However, this apparent advantage should be interpreted cautiously because most included studies used CMR, particularly late gadolinium enhancement CMR, as the reference standard rather than an independent imaging modality or pathological confirmation, and many studies were historical and used heterogeneous or non-optimized echocardiographic protocols. Further contemporary studies using independent validation standards are needed.<\/jats:p>\n                  <jats:p>Systematic Review Registration: PROSPERO CRD 42024558739<\/jats:p>","DOI":"10.1093\/ehjimp\/qyag150","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T19:23:31Z","timestamp":1789673011000},"source":"Crossref","is-referenced-by-count":0,"title":["Transthoracic echocardiography vs. cardiac magnetic resonance imaging for the diagnosis of left ventricular thrombus: an updated systematic review and diagnostic accuracy meta-analysis"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2237-9536","authenticated-orcid":false,"given":"Ernesto Calder\u00f3n","family":"Martinez","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Texas Tech University Health Science Center At El Paso , 2000 Transmountain, El Paso, TX 79912 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla Isabella Miret","family":"Durazo","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California Irvine School of Medicine, 2800 Chapman Avenue, Orange, CA 92868 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay","family":"Kumar","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Isra University Faculty of Medicine and Allied Medical Sciences , Hala Road, Hyderabad, Sindh 7100 ,","place":["Pakistan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"Pinto-Colmenarez","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universidad de Carabobo , Barbula, Valencia, Carabobo 2001 ,","place":["Venezuela"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0317-6787","authenticated-orcid":false,"given":"Palvi","family":"Mroke","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Caribbean Medical University , 5600 N River Road, Rosemont, IL 60018 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2845-4521","authenticated-orcid":false,"given":"Zishan","family":"Rahman","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Caribbean Medical University , 5600 N River Road, Rosemont, IL 60018 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5177-0772","authenticated-orcid":false,"given":"Ahmad","family":"Hammoud","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Ilia State University , Kakutsa Cholokashvili Avenue 2\/5, Tbilisi 0162 ,","place":["Georgia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imran","family":"Baig","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Houston Methodist West Hospital , 18500 Katy Freeway, TX 77094 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lakshmi Sree","family":"Pugalenthi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Mercy Catholic Medical Center , 1500 Lasdowne Avenue, Darby, PA 19023 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela Flores","family":"Monar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Miami\/Jackson Health System , 1611 NW 12th Avenue, Miami, FL 33136 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1394-7135","authenticated-orcid":false,"given":"Sachin","family":"Sapkota","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Texas Tech University Health Science Center At El Paso , 2000 Transmountain, El Paso, TX 79912 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3884-149X","authenticated-orcid":false,"given":"Diego","family":"Ramonfaur","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Cleveland Clinic , 9500 Euclid Avenue, Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,19]]},"reference":[{"key":"2026101704561251600_qyag150-B1","doi-asserted-by":"crossref","first-page":"358","DOI":"10.3390\/ijms23010358","article-title":"Temporal roles of platelet and coagulation pathways in collagen- and tissue factor-induced thrombus formation","volume":"23","author":"Navarro","year":"2021","journal-title":"Int J Mol Sci"},{"key":"2026101704561251600_qyag150-B2","doi-asserted-by":"crossref","first-page":"2370","DOI":"10.1161\/ATVBAHA.120.315754","article-title":"Thrombus structural composition in cardiovascular disease","volume":"41","author":"Alkarithi","year":"2021","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"2026101704561251600_qyag150-B3","doi-asserted-by":"crossref","first-page":"520","DOI":"10.21037\/atm-20-7839","article-title":"Management of left ventricular thrombus: a narrative review","volume":"9","author":"Cruz Rodriguez","year":"2021","journal-title":"Ann Transl Med"},{"key":"2026101704561251600_qyag150-B4","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.ahj.2005.08.021","article-title":"Clinical, imaging, and pathological characteristics of left ventricular thrombus: a comparison of contrast-enhanced magnetic resonance imaging, transthoracic echocardiography, and transesophageal echocardiography with surgical or pathological validation","volume":"152","author":"Srichai","year":"2006","journal-title":"Am Heart J"},{"key":"2026101704561251600_qyag150-B5","first-page":"785","article-title":"Echocardiography vs cardiac magnetic resonance imaging for the diagnosis of left ventricular thrombus: a systematic review","volume":"31","author":"Roifman","year":"2015","journal-title":"Can J Cardiol"},{"key":"2026101704561251600_qyag150-B6","doi-asserted-by":"crossref","first-page":"E205","DOI":"10.1161\/CIR.0000000000001092","article-title":"Management of patients at risk for and with left ventricular thrombus: a scientific statement from the American Heart Association","volume":"146","author":"Levine","year":"2022","journal-title":"Circulation"},{"key":"2026101704561251600_qyag150-B7","doi-asserted-by":"crossref","first-page":"180","DOI":"10.3390\/tomography7020016","article-title":"Left ventricular thrombi: insights from cardiac magnetic resonance imaging","volume":"7","author":"Chaosuwannakit","year":"2021","journal-title":"Tomography"},{"key":"2026101704561251600_qyag150-B8","doi-asserted-by":"crossref","first-page":"1667","DOI":"10.1016\/j.amjcard.2007.01.046","article-title":"Usefulness of contrast echocardiography for assessment of left ventricular thrombus after acute myocardial infarction","volume":"99","author":"Mansencal","year":"2007","journal-title":"Am J Cardiol"},{"key":"2026101704561251600_qyag150-B9","doi-asserted-by":"crossref","first-page":"qyad041","DOI":"10.1093\/ehjimp\/qyad041","article-title":"A systematic review and meta-analysis of transthoracic echocardiogram vs. cardiac magnetic resonance imaging for the detection of left ventricular thrombus","volume":"1","author":"Phuah","year":"2023","journal-title":"Eur Heart J Imaging Methods Pract"},{"key":"2026101704561251600_qyag150-B10","doi-asserted-by":"crossref","first-page":"n160","DOI":"10.1136\/bmj.n160","article-title":"PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"issue":"1","key":"2026101704561251600_qyag150-B11","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan-a web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst Rev"},{"key":"2026101704561251600_qyag150-B12","author":"Rohatgi"},{"key":"2026101704561251600_qyag150-B13","author":"Cochrane Collaboration"},{"key":"2026101704561251600_qyag150-B14","author":"StatsToDo"},{"key":"2026101704561251600_qyag150-B15","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/1471-2288-3-25","article-title":"The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews","volume":"3","author":"Whiting","year":"2003","journal-title":"BMC Med Res Methodol"},{"key":"2026101704561251600_qyag150-B16","volume-title":"Meta-Analysis with R","author":"Schwarzer"},{"key":"2026101704561251600_qyag150-B17","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.1002\/sim.3602","article-title":"Extending DerSimonian and Laird\u2019s methodology to perform multivariate random effects meta-analyses","volume":"29","author":"Jackson","year":"2010","journal-title":"Stat Med"},{"key":"2026101704561251600_qyag150-B18","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying heterogeneity in a meta-analysis","volume":"21","author":"Higgins","year":"2002","journal-title":"Stat Med"},{"key":"2026101704561251600_qyag150-B19","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1002\/jrsm.11","article-title":"Outlier and influence diagnostics for meta-analysis","volume":"1","author":"Viechtbauer","year":"2010","journal-title":"Res Synth Methods"},{"key":"2026101704561251600_qyag150-B20","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test","volume":"315","author":"Egger","year":"1997","journal-title":"BMJ"},{"key":"2026101704561251600_qyag150-B21","first-page":"100395","article-title":"Incidence and predictors of left ventricular thrombus formation following acute ST-segment elevation myocardial infarction: a serial cardiac MRI study","volume":"24","author":"Phan","year":"2019","journal-title":"Int J Cardiol Heart Vasc"},{"key":"2026101704561251600_qyag150-B22","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCIMAGING.119.009723","article-title":"Long-term embolic outcomes after detection of left ventricular thrombus by late gadolinium enhancement cardiovascular magnetic resonance imaging: a matched cohort study","volume":"12","author":"Velangi","year":"2019","journal-title":"Circ Cardiovasc Imaging"},{"key":"2026101704561251600_qyag150-B23","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.2214\/ajr.179.6.1791539","article-title":"Detection and characterization of intracardiac thrombi on MR imaging","volume":"179","author":"Barkhausen","year":"2002","journal-title":"AJR Am J Roentgenol"},{"key":"2026101704561251600_qyag150-B24","doi-asserted-by":"crossref","first-page":"2473","DOI":"10.1111\/jce.15177","article-title":"Diagnosis, significance, and management of ventricular thrombi in patients referred for VT ablation","volume":"32","author":"Beavers","year":"2021","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2026101704561251600_qyag150-B25","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1016\/j.jcmg.2009.03.017","article-title":"Contrast-enhanced anatomic imaging as compared to contrast-enhanced tissue characterization for detection of left ventricular thrombus","volume":"2","author":"Weinsaft","year":"2009","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026101704561251600_qyag150-B26","first-page":"703","article-title":"Improved detection of echocardiographically occult left ventricular thrombi following ST-elevation myocardial infarction enhanced reader","volume":"12","author":"Reindl","year":"2023","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"key":"2026101704561251600_qyag150-B27","doi-asserted-by":"crossref","first-page":"3900","DOI":"10.1016\/j.ejrad.2012.06.029","article-title":"Left ventricular thrombus formation after acute myocardial infarction as assessed by cardiovascular magnetic resonance imaging","volume":"81","author":"Delewi","year":"2012","journal-title":"Eur J Radiol"},{"key":"2026101704561251600_qyag150-B28","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.ahj.2015.04.029","article-title":"Incidence, diagnostic methods, and evolution of left ventricular thrombus in patients with anterior myocardial infarction and low left ventricular ejection fraction: a prospective multicenter study","volume":"170","author":"Meurin","year":"2015","journal-title":"Am Heart J"},{"key":"2026101704561251600_qyag150-B29","doi-asserted-by":"crossref","first-page":"2873","DOI":"10.1161\/01.CIR.0000044389.51236.91","article-title":"Visualization of ventricular thrombi with contrast-enhanced magnetic resonance imaging in patients with ischemic heart disease","volume":"106","author":"Mollet","year":"2002","journal-title":"Circulation"},{"key":"2026101704561251600_qyag150-B30","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1186\/1532-429X-14-69","article-title":"Potential clinical impact of cardiovascular magnetic resonance assessment of ejection fraction on eligibility for cardioverter defibrillator implantation","volume":"14","author":"Joshi","year":"2012","journal-title":"J Cardiovasc Magn Reson"},{"key":"2026101704561251600_qyag150-B31","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1007\/s10554-013-0357-9","article-title":"Detection of intracardiac masses in patients with coronary artery disease using cardiac magnetic resonance imaging: a comparison with transthoracic echocardiography","volume":"30","author":"Staab","year":"2014","journal-title":"Int J Cardiovasc Imaging"},{"key":"2026101704561251600_qyag150-B32","doi-asserted-by":"crossref","first-page":"w14122","DOI":"10.4414\/smw.2015.14122","article-title":"Thrombus formation in the left ventricle after large myocardial infarction - assessment with cardiac magnetic resonance imaging","volume":"145","author":"S\u00fcrder","year":"2015","journal-title":"Swiss Med Wkly"},{"key":"2026101704561251600_qyag150-B33","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.jcmg.2015.06.017","article-title":"Echocardiographic algorithm for post-myocardial infarction LV thrombus A gatekeeper for thrombus evaluation by delayed enhancement CMR","volume":"9","author":"Weinsaft","year":"2016","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026101704561251600_qyag150-B34","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1016\/j.jcmg.2011.03.017","article-title":"LV thrombus detection by routine echocardiography: insights into performance characteristics using delayed enhancement CMR","volume":"4","author":"Weinsaft","year":"2011","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026101704561251600_qyag150-B35","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/s44156-025-00092-1","article-title":"Detection of left ventricular thrombus in newly diagnosed heart failure patients: diagnostic accuracy of 2D transthoracic echocardiography compared with cardiac MRI in a Kenyan cohort","volume":"12","author":"Karau","year":"2025","journal-title":"Echo Res Pract"},{"key":"2026101704561251600_qyag150-B36","doi-asserted-by":"crossref","first-page":"1623","DOI":"10.1111\/echo.13668","article-title":"Echocardiography-quantified myocardial strain\u2014a marker of global and regional infarct size that stratifies likelihood of left ventricular thrombus","volume":"34","author":"Kim","year":"2017","journal-title":"Echocardiography"},{"key":"2026101704561251600_qyag150-B37","doi-asserted-by":"crossref","first-page":"143","DOI":"10.3904\/kjim.1995.10.2.143","article-title":"Evolution of left atrial thrombus with anticoagulant therapy -follow-up by transesophageal echocardiography","volume":"10","author":"Kim","year":"1995","journal-title":"Korean J Intern Med"},{"key":"2026101704561251600_qyag150-B38","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1159\/000487367","article-title":"Cardiac magnetic resonance imaging of the myocardium in chronic kidney disease","volume":"43","author":"Kis","year":"2018","journal-title":"Kidney Blood Press Res"},{"key":"2026101704561251600_qyag150-B39","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1161\/CIRCIMAGING.113.000498","article-title":"Use of cardiac magnetic resonance and echocardiography in population-based studies: why, where, and when?","volume":"6","author":"Marwick","year":"2013","journal-title":"Circ Cardiovasc Imaging"}],"container-title":["European Heart Journal - Imaging Methods and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjimp\/advance-article-pdf\/doi\/10.1093\/ehjimp\/qyag150\/71228842\/qyag150.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjimp\/article-pdf\/4\/4\/qyag150\/71228842\/qyag150.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjimp\/article-pdf\/4\/4\/qyag150\/71228842\/qyag150.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T08:56:23Z","timestamp":1792227383000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjimp\/article\/doi\/10.1093\/ehjimp\/qyag150\/8817582"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,19]]},"references-count":39,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,10,16]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjimp\/qyag150","relation":{},"ISSN":["2755-9637"],"issn-type":[{"value":"2755-9637","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2026,9,19]]},"article-number":"qyag150"}}