CLINICAL-SIGNIFICANCE OF INTRACAVITARY SPONTANEOUS ECHO CONTRAST IN PATIENTS WITH DILATED CARDIOMYOPATHY

To assess the occurence rate and major determinants of spontaneous ech o contrast and to examine its impact on thromboembolic events and mort ality in patients with dilated cardiomyopathy, 86 hospitalized patient s (73 men and 13 women, mean age 63 +/- 11 years) with dilated cardiom yopathy who underwent transthoracic and transesophageal echocardiograp hic examinations were followed up for a mean of 20 +/- 13 months. Spon taneous echo contrast was observed in 36 patients (42%) and was detect ed only with the transesophageal approach. It was seen in the left atr ium in 33 patients, in both right and left atria in 1 patient, in both left atrium and left ventricle in 1 patient, and in the descending ao rta in 1 patient. Spontaneous echo contrast was more frequent in the p resence of atrial fibrillation (p < 0.05), left atrial enlargement (p < 0.02) and severely depressed left ventricular function (p < 0.01), b ut was less common in patients with moderate to severe mitral regurgit ation (p < 0.05). This imaging phenomenon was the only significant ind ependent predictor of intracardiac thrombus formation and previous and subsequent thromboembolic events. During follow-up, there were 26 dea ths, and survival in patients with spontaneous echo contrast was signi ficantly lower than in those without it (p < 0.02). A spontaneous echo contrast is commonly detected with transesophageal echocardiography i n patients with dilated cardiomyopathy especially in the presence of a trial fibrillation, left atrial enlargement and severe left ventricula r dysfunction. This imaging phenomenon represents an important marker for thromboembolic risk and may influence the treatment and clinical o utcome of these patients.