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Predictors of left atrial spontaneous echocardiographic contrast or thrombus formation in stroke patients with sinus
Michael Handke1, Andreas Harloff, Andreas Hetzel
1Department of Cardiology and Angiology, Freiburg, Germany. handke@mm31.ukl.uni-freiburg.de
Insights
Patients with stroke and reduced left ventricular ejection fraction (EF) have a higher risk of left atrial spontaneous echocardiographic contrast (SEC) or thrombus. Lower EF and slower left atrial appendage (LAA) flow predict this risk.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Left atrial spontaneous echocardiographic contrast (SEC) or thrombus is a potential source of embolism in stroke patients.
- Left ventricular dysfunction is common in stroke patients and may influence left atrial stasis.
Purpose of the Study:
- To identify predictors of left atrial SEC or thrombus in stroke patients with sinus rhythm and left ventricular dysfunction.
- To assess the relationship between left ventricular ejection fraction (EF) and left atrial appendage (LAA) flow velocity with SEC or thrombus formation.
Main Methods:
- Retrospective analysis of 500 consecutive stroke patients.
- Echocardiographic assessment of 48 patients with sinus rhythm and reduced EF (< or =45%).
- Multivariate analysis to identify independent predictors of SEC or thrombus.
Main Results:
- Ten patients (20.8%) presented with SEC or thrombus.
- Patients with SEC or thrombus had significantly larger left atrial diameters, smaller EFs, and slower LAA flow velocities.
- Multivariate analysis identified EF < or =35% and LAA flow velocity < or =55 cm/s as significant predictors of SEC or thrombus.
Conclusions:
- Stroke patients with sinus rhythm and moderate-to-high grade left ventricular EF reduction are at risk for left atrial embolism.
- Transesophageal echocardiography is recommended for these high-risk patients to evaluate for left atrial sources of embolism.
Abstract:
The objective of the present study was to identify predictors of left atrial spontaneous echocardiographic contrast (SEC) or thrombus in patients with stroke with sinus rhythm and left ventricular dysfunction. Of 500 consecutive patients with stroke, 48 with sinus rhythm and reduced left ventricular ejection fractions (EFs) < or =45% were examined. Ten patients presented with SEC or thrombus. The patients with SEC or thrombus had larger left atrial diameters (47 +/- 4 vs 42 +/- 6 mm, p <0.05), smaller EFs (30 +/- 9% vs 38 +/- 8%, p <0.01), and slower left atrial appendage (LAA) flow velocities (42 +/- 13 vs 61 +/- 17 cm/s, p <0.01). Multivariate analysis identified EF < or =35% and LAA flow velocity < or =55 cm/s as predictors of SEC or thrombus (p <0.05). Patients with stroke with sinus rhythm and moderate- to high-grade reduction of the left ventricular EF represent a risk group for a left atrial source of embolism and should undergo transesophageal echocardiography.
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