SIGNIFICANCE OF LEFT ATRIAL SPONTANEOUS ECHO CONTRAST IN RHEUMATIC MITRAL-VALVE DISEASE AS A PREDICTOR OF SYSTEMIC ARTERIAL EMBOLIZATION - A TRANSESOPHAGEAL ECHOCARDIOGRAPHIC STUDY

The association between left atrial spontaneous echo contrast (SEC) an d a history of systemic arterial embolization was evaluated in 359 con secutive patients with rheumatic mitral valve disease during a 3-year period. All patients underwent transesophageal echocardiographic (TEE) and cardiac catheterization studies. Of these, 207 patients had predo minant mitral stenosis, 55 had significant mitral regurgitation, and t he remaining 97 with xenograft mitral valve replacement developed valv ular dysfunction (32 resulted in predominant mitral stenosis and 65 in significant mitral regurgitation). Left atrial SEC was detected in 10 8 patients (group A) and was absent in 251 (group B). Group A patients showed a higher frequency of left atrial thrombi or history of previo us embolization than those in group B (59.3% vs 7.2%; p < 0.001). Grou p A patients also had a higher frequency of recent (less than or equal to 1 week before TEE study) and remote (>1 week before TEE study) emb olization than did group B patients (recent: 19.4% vs 2.8% p < 0.001 ; remote: 13.0% vs 4.0% p < 0.001). Multivariate analysis showed tha t left atrial SEC (p = 0.01) was the only independent predictor of sys temic arterial embolization. It is concluded that patients with left a trial SEC had a significantly higher risk for thromboembolism, and TEE is a useful modality to identify this subset of patients with rheumat ic mitral valve disease.