Related Experiment Videos
[Transthoracic and transesophageal follow-up in patients with left atrial thrombosis]
Insights
Left atrial thrombi pose an embolic risk, with 14% per patient year observed. Anticoagulation helps but doesn't fully prevent embolism or recurrence, with spontaneous echo contrast being a key risk factor.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Left atrial thrombi are a significant concern in cardiovascular disease.
- Understanding their embolic potential and response to treatment is crucial for patient management.
Purpose of the Study:
- To investigate the embolic risk associated with left atrial thrombi.
- To evaluate changes in thrombus size and location over time.
- To assess the efficacy of anticoagulation therapy in preventing embolism and thrombus recurrence.
Main Methods:
- Prospective study of 29 patients with echocardiographically confirmed left atrial thrombi.
- Transesophageal echocardiography used for initial diagnosis and follow-up (mean 18 months).
- Analysis of embolic events, thrombus resolution, and recurrence in relation to treatment.
Main Results:
- An embolic rate of 14% per patient year was observed.
- Anticoagulation (phenprocoumon or aspirin) did not completely prevent embolism or recurrence in all cases.
- Thrombi completely resolved in 12 patients, while 2 experienced recurrence despite anticoagulation.
- Left atrial spontaneous echo contrast was the sole significant risk factor for thromboembolism.
Conclusions:
- Anticoagulation therapy benefits most patients with left atrial thrombi but does not offer complete protection against arterial embolism or recurrence.
- Left atrial spontaneous echo contrast is a critical predictor of thromboembolic events.
- Further research may be needed to optimize management strategies for left atrial thrombi.
Abstract:
The embolic risk and changes of thrombus location and size were investigated in 29 consecutive patients with echocardiographically proven thrombi in the left atrium. Inclusion criteria were the visualization of a left atrial thrombus using transesophageal echocardiography. Transesophageal follow-up echocardiograms were performed at a mean period of 18 months. In this period 6 cases of embolism were observed at an interval of 20 days to 26 months after the detection of thrombus. Thus, the embolic rate was 14% per patient year. All patients received phenprocoumon (n = 4) or aspirin at the time of embolism. Furthermore, in two patients after cardiac thrombectomy left atrial thrombi were seen again although patients were treated with anticoagulants. On the other hand, in 12 patients (5 received oral anticoagulation, 2 received aspirin) thrombi completely resolved. It can be concluded from these data, that the majority of patients receiving anticoagulation profit from this therapy, however, a complete protection against arterial embolism or reoccurrence of thrombi cannot be reached. Left atrial spontaneous echo contrast was the only risk factor significantly associated with thromboembolism in patients with left atrial thrombi.