Incidence and dynamic nature of spontaneous echocardiographic contrast andatrial thrombi in heart transplantation

Background. Standard orthotopic heart transplantation produces important an atomic and functional atrial alterations with subsequent thrombotic risk. T herefore the aim of this study was to analyze the prevalence and evolution of spontaneous echocardiography, atrial thrombi and embolic events. Patients and method. 52 consecutive transplanted patients were analyzed wit h transesophageal echocardiography and hemodynamic studies performed at 15 days and one year after transplantation. Results. Spontaneous echocardiography contrast was present in 27 patients ( 52%). Ten atrial thrombi were observed (19.2%), 9 with spontaneous echocard iography contrast. Six atrial thrombi appeared on day 15 and 4 after one ye ar (with spontaneous echocardiography contrast on the previous study). Usin g multiple logistic regression analysis left atrial size was the only indep endent predictor factor for spontaneous echocardiography contrast (OR = 1.2 7; 95% CI, 1.09-1.54) and was an important predictor factor of atrial throm bi formation (OR = 1.19; 95% CI, 1.04-1.42). Likewise, the main predictor o f atrial thrombi was the presence of spontaneous echocardiography contrast (OR = 116; 95% CI, 8.4-999). The hemodynamic pattern did not predict either the presence of spontaneous echocardiography contrast or atrial thrombi. T he global incidence of embolic events was 4% less than previously described . Conclusions. The incidence of atrial thrombi and spontaneous echocardiograp hic contrast after standard orthotopic heart transplantation was 19.2% and 52%, respectively. An enlarged atrium and/or spontaneous echocardiography c ontrast was found to increase the risk of atrial thrombi. Considering the d ynamic nature of atrial thrombi formation, periodical transesophageal echoc ardiography studies are recommended after heart transplantation.