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Predictors of Spontaneous Echo Contrast in Left Heart Chambers in Patients with Dilated Cardiomyopathy: Slowing Down
Aurora Bakalli1, Ljubica Georgievska-Ismail2, Xhevdet Krasniqi1
1Clinic of Invasive Cardiology and Cardiosurgery, University Clinical Center of Kosova, Pristina, Kosovo.
Insights
Spontaneous echo contrast (SEC) is common in dilated cardiomyopathy patients. Lower heart rate, reduced ejection fraction, larger chamber sizes, and elevated C-reactive protein predict SEC, indicating embolic risk.
Area of Science:
- Cardiology
- Echocardiography
- Cardiovascular Imaging
Background:
- Spontaneous echo contrast (SEC) in heart chambers is linked to reduced blood flow velocity.
- SEC is clinically significant due to its association with embolic events.
- Dilated cardiomyopathy (DCM) is a condition characterized by enlarged heart chambers and impaired systolic function.
Purpose of the Study:
- To determine the frequency of SEC in the left heart chambers of patients with DCM in sinus rhythm.
- To identify predictors for the emergence of SEC in these patients.
Main Methods:
- Prospective, cross-sectional transesophageal echocardiography (TEE) study.
- Inclusion of 101 patients with DCM and mild-to-moderate systolic dysfunction in sinus rhythm.
- Statistical analysis including multiple regression to identify independent predictors.
Main Results:
- Moderate SEC was observed in the left ventricle (9%), left atrium (12%), and left atrial appendage (40%).
- Predictors for LV SEC included lower heart rate and larger LV end-systolic diameter.
- Lower LV ejection fraction predicted LA SEC, while lower heart rate, larger LA diameter, and higher CRP predicted LAA SEC.
Conclusions:
- SEC is a frequent finding in the left heart chambers of DCM patients in sinus rhythm.
- Predictors identified include lower heart rate, reduced LVEF, larger LV and LA dimensions, and elevated CRP.
- Lower heart rate may be a key predictor for SEC presence and severity in this population.
Introduction:
Spontaneous echo contrast(SEC) is usually detected in heart chambers as a result of reduced flow velocity in the cavity. The clinical importance of SEC lies in its association with embolic events. The aim of our study was to determine the frequency of SEC in left heart chambers in sinus rhythm patients with dilated cardiomyopathy and predictors for its emergence.
Materials And Methods:
This was a prospective cross-sectional transesophageal echocardiography study conducted in 101 sinus rhythm patients with dilated heart and mild-to-moderate systolic dysfunction.
Results:
Moderate-degree SEC was found in the left ventricle(LV) in around 9% of patients, in the left atrium(LA) in 12% and in left atrial appendage(LAA) in 40%. Multiple regression analysis showed that lower heart rate(95% confidence interval[CI]: 0.845-0.978; P = 0.011) and larger LV end-systolic diameter(LVESD)(95% CI: 1.034-1.394; P = 0.017) were independent predictors for LV SEC presence. Lower LV ejection fraction(LVEF) (95% CI: [-0.079]-[-0.037]; P = 0.0001) was the only independent predictor for SEC in the LA. Whereas, independent predictors for SEC in LAA were lower heart rate(95% CI:[-0.030]-[-0.003]; P = 0.018), greater LA indexed diameter (95% CI: 0.016-0.116; P = 0.010), and higher value of C-reactive protein(CRP)(95% CI: 0.0026-0.031; P = 0.027).
Conclusions:
SEC in left heart chambers is a frequent finding in patients with dilated cardiomyopathy in sinus rhythm. Lower heart rate and LVEF, larger LVESD and LA, as well as higher CRP, predict the presence of SEC in left heart chambers. Lower heart rate might be an essential predictor for SEC presence and severity in these patients.
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