SPONTANEOUS ECHO CONTRAST ON TRANSTHORACIC ECHOCARDIOGRAPHY AND LEFT ATRIAL THROMBUS IN RHEUMATIC MITRAL-VALVE DISEASE PATIENTS - A CLINICOPATHOLOGICAL STUDY
C. Wanishsawad et al., SPONTANEOUS ECHO CONTRAST ON TRANSTHORACIC ECHOCARDIOGRAPHY AND LEFT ATRIAL THROMBUS IN RHEUMATIC MITRAL-VALVE DISEASE PATIENTS - A CLINICOPATHOLOGICAL STUDY, Clinical cardiology, 17(10), 1994, pp. 547-551
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.