Prognostic significance of spontaneous echocardiographic contrast detected by transthoracic and transesophageal echocardiography in the era of harmonic imaging

Abstract

IntroductionEchocardiographic diagnosis of spontaneous intracardiac contrast is the reflection of interactions between erythrocytes and plasma proteins. Underlying conditions are associated with low blood flow velocities in the heart. We sought to determine whether spontaneous echo contrast (SEC) detected in the era of widespread use of harmonic imaging still reflects poor prognosis and risk of thromboembolism.Material and methodsWe retrospectively analyzed the database of a tertiary cardiology centre echocardiographic laboratory and identified 60 patients with SEC, but without solid intracardiac structures, and subsequently selected 60 sex- and age-matched controls without SEC. Data regarding baseline characteristics, treatment and clinical course during follow-up (median: 33.5 months; 95% CI: 24.79–40) were gained based on hospital and out-patient clinic documentation and telephone interviews. The clinical end-points included: all-cause death, cardiovascular death, stroke or transient ischemic attack (TIA), pulmonary embolism, peripheral embolism and composite thromboembolic end-point.ResultsWe observed that in the whole study group (p = 0.0016) and in the subgroup evaluated by TTE (p = 0.005) SEC predicted higher mortality. In the group assessed by TEE, SEC correlated with higher probability of stroke or TIA (p = 0.04). By multivariate analysis, in all patients SEC was a predictor of cardiovascular death (OR = 7.63; p = 0.008) and its localization in the left atrium independently predisposed to thromboembolism (OR = 10.15; p = 0.012). Furthermore, left ventricular SEC detected by TTE also emerged as an independent determinant of higher mortality (OR = 5.26; p = 0.015).ConclusionsDespite a lower threshold of detection using harmonic imaging SEC is still a risk factor of poor prognosis, especially when observed on transthoracic examination.

Incremental value of left atrial mechanical dispersion over CHA2DS2‐VASc score in predicting risk of thrombus formation

“…11,12 A dysfunction in contractility leads to reduced blood flow velocity and aids the development of thrombi. 27,30,31 Previous studies established that the presence of LAAT is associated with higher CHADS 2 and CHA 2 DS 2 -VASc scores, reduced LVEF, LV diastolic dysfunction, increased iLV mass, iLA volume, B-type natriuretic peptide level, and restricted motion of the left atrial appendage. 12,25,26,29,32 Several of these outcomes were also confirmed in the current study.…”

Arrhythmogenecity and thrombogenicity of the residual left atrial appendage stump following surgical exclusion of the appendage in patients with atrial fibrillation

“…31 In an earlier trial, the linearized rates of the thromboembolic event at 5-year follow-up in post-Maze IV patients without anticoagulation was 0.06%. 39,40 In the study conducted by Kupczyńska et al, 39 the SEC in LA was a significant prognostic factor of the composite thromboembolic endpoint in the multivariate model. 39,40 In the study conducted by Kupczyńska et al, 39 the SEC in LA was a significant prognostic factor of the composite thromboembolic endpoint in the multivariate model.…”

“…16 Indeed, the three patients in our study experiencing TIA had large to be closely associated with future TE events. 39,40 In the study conducted by Kupczyńska et al, 39 the SEC in LA was a significant prognostic factor of the composite thromboembolic endpoint in the multivariate model. In another study by Zhao et al, 41 patients who developed stroke had a higher detection rate of left atrial smoke than those who did not.…”

Assessment of left atrial appendage function by transthoracic pulsed Doppler echocardiography: Comparing against transesophageal interrogation and predicting echocardiographic risk factors for stroke

“…Impaired left atrial appendage (LAA) blood flow promotes thrombus formation . The presence of thrombus and spontaneous echo contrast (SEC) substantially increases the risk of cardioembolic stroke . Transesophageal echocardiography (TEE) is the gold standard approach to detect the presence of thrombus or SEC in the posteriorly located LAA .…”

“…1,2 The presence of thrombus and spontaneous echo contrast (SEC) substantially increases the risk of cardioembolic stroke. [3][4][5][6] Transesophageal echocardiography (TEE) is the gold standard approach to detect the presence of thrombus or SEC in the posteriorly located LAA. 7,8 In addition to the conventional clinical risk scores (CHADS2 and CHA2DS2 VASc scores), these TEE echocardiographic risk factors are used to guide management in patients with atrial Shin Hnin Wai and Kyu Kyu are contributed equally to this work.…”