Related Experiment Videos
Clinical implications of left atrial spontaneous echo contrast in mitral valve disease
A Kranidis1, S Koulouris, L Anthopoulos
1First Department of Cardiology, Evangelismos Hospital, Athens, Greece.
Insights
Left atrial spontaneous echo contrast in mitral valve disease, detected by transesophageal echocardiography, predicts thromboembolism. Its presence correlates with atrial fibrillation and enlarged left atrium, indicating low blood flow velocity.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Mitral valve disease is associated with thromboembolic events.
- Left atrial spontaneous echo contrast (LASEC) is a potential marker for these events.
Purpose of the Study:
- To investigate factors associated with LASEC in mitral valve disease.
- To determine if LASEC predicts thromboembolism.
Main Methods:
- 101 patients with mitral valve disease underwent transthoracic and transesophageal echocardiography.
- Factors associated with LASEC and thromboembolism were analyzed.
Main Results:
- Transesophageal echocardiography detected LASEC in 58 patients, significantly more than transthoracic.
- LASEC correlated with atrial fibrillation, enlarged left atrium, and mitral stenosis severity.
- LASEC was the sole independent predictor of thromboembolism (p < 0.0001).
Conclusions:
- LASEC is best detected by transesophageal echocardiography in mitral valve disease.
- LASEC is linked to conditions causing low left atrial blood flow.
- LASEC is a significant independent predictor of thromboembolism.
Abstract:
The aim of this study was to investigate the factors related to the presence of left atrial spontaneous echo contrast in mitral valve disease, and to ascertain whether it is a predictor of thromboembolism. One hundred and one patients (47 men, 54 women) with a mean age of 57.04 +/- 10.6 years who underwent transthoracic and transesophageal echocardiography were included in the study. Forty-five (44.5%) had isolated or predominant mitral valve stenosis, 12 (11.9%) predominant mitral insufficiency and 44 (43.6%) had had previous mitral valve replacement. Left atrial spontaneous echo contrast was detected by transesophageal echocardiography in 58 patients, while the transthoracic approach detected it in only 15 (14.9%) (P < 0.0001). An atrial thrombus was found in six cases, with a history of recent systemic embolism in three of them. There was no thrombus in the left atria of a further nine patients, despite definitive histories of recent systemic embolism. The finding of left atrial spontaneous echo contrast was related to the presence of atrial fibrillation or enlarged left atrium, the severity of mitral stenosis and the absence of significant mitral insufficiency. Anticoagulant therapy was not significantly associated with spontaneous left atrial echo contrast, but a stepwise linear regression analysis showed that its presence was the only independent predictor of thromboembolism (p < 0.0001). We conclude that left atrial spontaneous echo contrast in mitral valve disease can be discovered mainly by transesophageal echocardiography, and is correlated with factors which are associated with low left atrial blood flow velocity such as atrial fibrillation, enlarged left atrium, mitral stenosis of increased severity and the absence of significant mitral insufficiency.(ABSTRACT TRUNCATED AT 250 WORDS)