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Correlates of spontaneous echo contrast in patients with mitral stenosis and normal sinus rhythm
N E Bernstein1, L A Demopoulos, P A Tunick
1Charles and Rose Wohlstetter Noninvasive Cardiology Laboratory, Department of Medicine, New York University Medical Center, NY 10016.
Insights
Spontaneous echo contrast is common in mitral stenosis patients with normal sinus rhythm. This finding correlates with a smaller mitral valve area and higher transmitral gradient, indicating increased disease severity.
Area of Science:
- Cardiology
- Echocardiography
- Medical Imaging
Background:
- Spontaneous echo contrast (SEC) is linked to clot formation and embolism.
- SEC is observed in conditions with blood stasis, such as mitral stenosis and atrial fibrillation.
- Correlates of SEC in mitral stenosis with normal sinus rhythm require further evaluation.
Purpose of the Study:
- To evaluate the correlates of spontaneous echo contrast in patients with mitral stenosis and normal sinus rhythm.
- To determine the association between SEC and echocardiographic and clinical findings in this patient group.
Main Methods:
- Retrospective review of 47 patients with mitral stenosis and normal sinus rhythm.
- Analysis of transthoracic and transesophageal echocardiograms and clinical data.
- Measurement of left atrial size, mean transmitral gradient, and mitral valve area; noting presence of SEC.
Main Results:
- SEC was present in 45% of patients (21/47).
- Patients with SEC had a significantly higher mean transmitral gradient (13.6 vs 10.5 mm Hg) and smaller mitral valve area (1.0 vs 1.4 cm²).
- No significant differences were found in age, left atrial size, embolism history, or warfarin therapy.
Conclusions:
- Spontaneous echo contrast is a common finding in mitral stenosis patients with normal sinus rhythm.
- SEC in this population is associated with more severe mitral stenosis, indicated by smaller valve area and higher gradient.
- Further research may explore SEC as a marker for embolic risk in this specific patient group.
Abstract:
The purpose of this study was to evaluate the correlates of spontaneous echo contrast in mitral stenosis and normal sinus rhythm. Spontaneous echo contrast is associated with clot formation and embolic phenomena. It has been noted in conditions involving blood stasis, especially mitral stenosis and atrial fibrillation, but the correlates of spontaneous echo contrast in patients with mitral stenosis and normal sinus rhythm have not been extensively evaluated. The transthoracic and transesophageal echocardiograms and clinical findings of 47 patients with mitral stenosis and normal sinus rhythm were reviewed. Left atrial size, mean transmitral gradient, and valve area were measured, and the presence or absence of spontaneous echo contrast in the left atrium was noted. Spontaneous echo contrast was found in the echocardiograms of 21 (45%, group 1) of 47 patients. There was no contrast in those of the other 26 patients (group 2). Mean transmitral gradient was significantly higher in group 1 (13.6 +/- 5.2 mm Hg) than in group 2 (10.5 +/- 4.9 mm Hg) (p < 0.05). Mitral valve area was significantly smaller in group 1 than in group 2 (1.0 +/- 0.5 vs 1.4 +/- 0.5 cm2; p < 0.02). There was a trend toward a higher prevalence of significant mitral regurgitation in group 2. There was no significant difference with respect to age, left atrial size, history of embolism, or warfarin therapy. We conclude that spontaneous echo contrast in the left atrium of patients with mitral stenosis and normal sinus rhythm is common and is associated with a significantly smaller mitral valve area and higher mitral gradient.(ABSTRACT TRUNCATED AT 250 WORDS)