STUDY OF PREVALENCE AND FACTORS INFLUENCING THE OCCURRENCE OF LEFT ATRIAL/ LEFT ATRIAL APPENDAGE CLOT IN PATIENTS WITH RHEUMATIC HEART DISEASE & MITRAL STENOSIS IN SINUS RHYTHM VS ATRIAL FIBRILLATION.

Abstract

BACKGROUND: The purpose of this study was to prospectively evaluate a large group of consecutive, non-anticoagulated patients with RHD (rheumatic mitral stenosis) and to analyze the left atrial appendage function in relation to left atrial appendage clot and spontaneous echo contrast formation in patients who were in SR vs. in AF. METHODS AND RESULTS: This is a hospital based observational study conducted in department of cardiology, S. M. S. MEDICAL COLLEGE and associated hospital, Jaipur, Rajasthan; between march 2016 to august 2017. We prospectively studied clinical and echocardiographic parameters of LA/LAA in 303 consecutive patients with mitral stenosis who underwent trans-esophageal echocardiography and correlated it with spontaneous echo contrast and left atrial appendage clot. The mean age of the patients was 32.94 years. One hundred thirty seven (45.21%) patients were in atrial fibrillation and 166 (54.79%) patients were in sinu rhythm. We found a statistically significant difference in the age of presentation (29.16/33.93/36.68 Yr; P =0.006/<0.001), MVA (1.17/0.8/0.69 cm2; P=<0.001/0.024), LA diameter (39/47.24/50 cm; P=<0.001/<0.001), LAA emptying velocity (45/26.43/15 cm/sec; P=<0.001/<0.001) and EF (37.49/30.67/23.7%; P=<0.001/0.001) among the patients without spontaneous echo contrast /clot vs. with spontaneous echo contrast vs. with spontaneous echo contrast & clot. By using student t-test, we found that there was a statistically significant difference in age of presentation, BMI, MDG, LA diameter, LAA emptying velocity and EF in patients who were in sinus rhythm vs. atrial fibrillation (P<0.05). Incidence of spontaneous echo contrast was 68.67% vs. 91.97% in patients in sinus rhythm vs atrial fibrillation, while that of SEC & CLOT both was 4.22% vs. 33.58% in patients in SR vs AF. In a subgroup of the patients with LA/LAA clot, the LA diameter (55.14 : 49.98 CM; P=0.057) and the LAA emptying velocity ( 15.14 : 15.26 CM/Sec; P=0.923) were not significantly different among patients in SR vs in AF. CONCLUSION: In the patients with severe mitral stenosis, besides atrial fibrillation, a subgroup of patients in normal sinus rhythm with depressed left atrial appendage function had a higher risk of clot formation in left atrial appendage and these patients should be routinely anticoagulated for prevention of clot formation.