SPONTANEOUS ECHO CONTRAST ON TRANSTHORACIC ECHOCARDIOGRAPHY AND LEFT ATRIAL THROMBUS IN RHEUMATIC MITRAL-VALVE DISEASE PATIENTS - A CLINICOPATHOLOGICAL STUDY

The association of spontaneous echo contrast and thrombus in the left atrium in patients with mitral valve disease is controversial. This st udy was undertaken to determine whether there is an independent associ ation between spontaneous echo contrast on transthoracic echocardiogra phy (TTE) and intraoperative evidence of left atrial thrombus and to e valuate the clinical implications of spontaneous echo contrast in pati ents with symptomatic rheumatic mitral valve disease. A total of 255 p atients who underwent surgery for rheumatic mitral valve diseases were preoperatively evaluated by transthoracic two-dimensional and Doppler echocardiography. Spontaneous echo contrast in the left atrium was ca refully sought. The left atrium was carefully searched for evidence of thrombus intraoperatively. The association of spontaneous echo contra st and left atrial thrombus was determined by univariate and multivari ate analysis. Of the patients studied, 77 (30%) had left atrial thromb us. Left atrial thrombus was found in 47 and 21% of patients with and without spontaneous echo contrast, respectively (p < 0.001). Spontaneo us echo contrast and atrial fibrillation were found to be the only two independent predictors of left atrial thrombus (odds ratio = 2.16; 95 % confidence interval 1.15-4.04 p < 0.05, and odds ratio = 6.98; 95% c onfidence interval 3.45-14.16, p < 0.001, respectively). It was conclu ded that there is an independent association between spontaneous echo contrast on TTE and left atrial thrombus in patients with mitral valve disease requiring surgical correction. These patients are at high ris k for left atrial thrombus and should, therefore, be considered for lo ng-term anticoagulation.