CORRELATES OF SPONTANEOUS ECHO CONTRAST IN PATIENTS WITH MITRAL-STENOSIS AND NORMAL SINUS RHYTHM

The purpose of this study was to evaluate the correlates of spontaneou s echo contrast in mitral stenosis and normal sinus rhythm. Spontaneou s echo contrast is associated with clot formation and embolic phenomen a. It has been noted in conditions involving blood stasis, especially mitral stenosis and atrial fibrillation, but the correlates of spontan eous echo contrast in patients with mitral stenosis and normal sinus r hythm have not been extensively evaluated. The transthoracic and trans esophageal echocardiograms and clinical findings of 47 patients with m itral stenosis and normal sinus rhythm were reviewed. Left atrial size , mean transmitral gradient, and valve area were measured, and the pre sence or absence of spontaneous echo contrast in the left atrium was n oted. Spontaneous echo contrast was found in the echocardiograms of 21 (45%, group 1) of 47 patients. There was no contrast in those of the other 26 patients (group 2). Mean transmitral gradient was significant ly higher in group 1 (13.6 +/- 5.2 mm Hg) than in group 2 (10.5 +/- 4. 9 mm Hg) (p < 0.05). Mitral valve area was significantly smaller in gr oup 1 than in group 2 (1.0 +/- 0.5 vs 1.4 +/- 0.5 cm(2); p < 0.02). Th ere was a trend toward a higher prevalence of significant mitral regur gitation in group 2. There was no significant difference with respect to age, left atrial size, history of embolism, or warfarin therapy. We conclude that spontaneous echo contrast in the left atrium of patient s with mitral stenosis and normal sinus rhythm is common and is associ ated with a significantly smaller mitral valve area and higher mitral gradient. The role of anticoagulation in these patients needs to be pr ospectively evaluated.