Related Experiment Videos
Contributing factors to formation of left atrial spontaneous echo contrast in mitral valvular disease
1Division of Cardiology, Taichung Veterans General Hospital, Taiwan, Republic of China.
Insights
Left atrial spontaneous echo contrast, often linked to blood stasis, is more prevalent in patients with mitral obstruction and atrial fibrillation. Transesophageal echocardiography significantly improves detection compared to transthoracic methods.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Left atrial spontaneous echo contrast (LASEC) is associated with blood stasis.
- Understanding factors influencing LASEC formation is crucial for clinical assessment.
Purpose of the Study:
- To analyze factors contributing to the formation of left atrial spontaneous echo contrast.
- To compare the diagnostic yield of transesophageal echocardiography (TEE) versus transthoracic echocardiography (TTE) for LASEC detection.
Main Methods:
- 139 patients were divided into five groups based on mitral valve condition and heart rhythm.
- Diagnostic procedures included transesophageal echocardiography, transthoracic echocardiography, cardiac catheterization, and left ventricular angiography.
- Groups included mitral stenosis with atrial fibrillation, normal valve with atrial fibrillation, mitral stenosis with sinus rhythm, mitral regurgitation with atrial fibrillation, and atrial fibrillation with a normal mitral valve.
Main Results:
- LASEC was detected in only 1/139 patients by TTE, but in 62/139 by TEE.
- High incidence of LASEC observed in mitral obstruction with atrial fibrillation and enlarged left atrium (88% and 74%).
- Lower incidence noted in normal sinus rhythm (4%), atrial fibrillation alone (16%), and increased left atrial flow velocity (9.5%).
- Left atrial diameter was significantly larger in patients with LASEC (54.3 ± 9.2 mm vs. 48.3 ± 8.6 mm, p < 0.01).
Conclusions:
- Mitral obstruction, particularly with atrial fibrillation and left atrial enlargement, strongly correlates with LASEC.
- TEE is superior to TTE for detecting LASEC.
- LASEC formation is influenced by hemodynamic factors and left atrial dimensions.
Abstract:
The formation of left atrial spontaneous echo contrast may relate to blood stasis. This study analyzed the factors contributing to the formation of that contrast. Transesophageal echocardiography, transthoracic echocardiography, cardiac catheterization, and left ventricular angiography were performed in 139 patients, divided into five groups. Predominant mitral stenosis with atrial fibrillation was found in 36 patients (group I); normal porcine valve in the mitral valvular area with atrial fibrillation in 31 (group II); predominant mitral stenosis with normal sinus rhythm in 26 (group III); moderate to severe mitral regurgitation with atrial fibrillation in 25 (group IV); atrial fibrillation with normal mitral valve in 21 (group V). The results showed left atrial spontaneous contrast echo was found in only 1 of 139 patients by transthoracic echocardiography and 62 of 139 cases were detected by transesophageal echocardiography. There was a high incidence of left atrial spontaneous echo contrast in cases of mitral obstruction with atrial fibrillation and enlarged left atrium (group I, 88%; group II, 74%), but a lower incidence in cases with normal sinus rhythm (group III, 4%), atrial fibrillation alone (group V, 16%), and increased left atrial flow velocity (group IV, 9.5%). The diameter of the left atrium was significantly different between presence and absence of left atrial spontaneous contrast echo (54.3 +/- 9.2 mm vs. 48.3 +/- 8.6 mm, p less than 0.01). The mean pressure gradient was similar in groups I and III (14.6 +/- 0.6 mHg and 14.4 +/- 2.8 mHg, respectively) but different in group II (10.9 +/- 3.2 mHg, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)