[Predictive factors of thromboembolic complications in mitral stenosis in sinus rythm]

The authors analyse the predisposing factors to the development of thromboembolic complications in mitral stenosis in sinus rhythm and propose preventive therapeutic measures. Eighty five consecutive patients with pure or very predominant mitral stenosis in sinus rhythm were included in this study and divided into two groups according to the presence (Group I: n = 27, age: 34.2 +/- 8.31 years) or absence (Group II: n = 58, age: 32.6 +/- 9.7 years) of thromboembolic complications. No significant difference was observed between the two groups for age, sex and functional class. Patients of group I had a more dilated left auricle (57.3 +/- 4.5 vs 48.4 +/- 4.7 mm; p < 0.001) and a smaller mitral surface area (0.8 +/- 0.15 vs 1.1 +/- 0.21 cm2, p < 0.05). The spontaneous left intra-atrial contrast phenomenon was more frequently observed in patients with thromboembolic complications (23 out of 27) than in those not presenting this complication (17 out of 58), (p < 0.001). This phenomenon was the only independent predictive factor on multivariate analysis. In conclusion, left atrial dilatation, the severity of mitral stenosis and especially the presence of spontaneous contrast are the main predictive factors of the development of thromboembolic complications in mitral stenosis in sinus rhythm. Patients presenting one or several of these factors may benefit from prophylactic anticoagulant treatment.