Clinical and Echocardiographic Characteristics of Patients With Left Atrial Thrombus and Sinus Rhythm

Agmon, Yoram; Khandheria, Bijoy K.; Gentile, Federico; Seward, James B.

doi:10.1161/hc0102.101776

Cited by 99 publications

(73 citation statements)

References 31 publications

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“…In patients with major cardiac risk factors (thrombi in the left atrium, left atrial appendage and left ventricle, dilated cardiomyopathy) anticoagulation therapy is generally recommended. 2,13,14 Anticoagulation is probably even more warranted after a thromboembolic event like a TIA or stroke, although there is no evidence at this time from randomizedcontrolled trials. Recruitment for these trials would probably also be difficult because large numbers of stroke patients are needed.…”

Section: Discussionmentioning

confidence: 99%

Transesophageal Echocardiography Is Superior to Transthoracic Echocardiography in Management of Patients of Any Age With Transient Ischemic Attack or Stroke

Bruijn

Agema²,

Lammers³

et al. 2006

Stroke

190

159

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Background and Purpose-The merits of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in the management of transient ischemic attack (TIA) and stroke patients remains matter of debate. Methods-Two hundred and thirty-one consecutive patients with a recent TIA or stroke for which no definite cause and indication for anticoagulation was assessed after standardized work-up underwent TTE and TEE. Echocardiographic findings were categorized into minor and major risk factors. Results-A potential cardiac source of embolism was detected in 55% (127/ 231) of the patients by echocardiography, in 39% (90/231) only identified on TEE. Major risk factors, with an absolute indication for oral anticoagulation, were detected in 20% (46/231) of the patients, in 16% (38/231) of all patients identified on TEE only. A thrombus in the left atrial appendage was the most common major risk factor (38 patients, 16%). The presence of major risk factors was independent of age ( 2 ϭ1.48; Pϭ0.224). The difference in proportions of cardiac sources detected in favor of TEE was highly significant in both patients Յ45 years of age (10/39, Pϭ0.002) and in those Ͼ45 years of age (80/192; PϽ0.004). Conclusions-TEE proved superior to TTE for identification of a cardiac embolic source in patients with TIA or stroke without pre-existent indication or contraindication for anticoagulation. In patients with normal TTE, a cardiac source of embolism was detected by TEE in Ϸ40% of patients, independent of age. More than 1 of 8 patients of any age with normal TTE revealed a major cardiac risk factor on TEE, in whom anticoagulation is warranted. (Stroke. 2006;37:2531-2534.)

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Section: Discussionmentioning

confidence: 99%

Transesophageal Echocardiography Is Superior to Transthoracic Echocardiography in Management of Patients of Any Age With Transient Ischemic Attack or Stroke

Bruijn

Agema²,

Lammers³

et al. 2006

Stroke

190

159

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“…LAA is a favorable site for stasis and thrombus formation, when the strength of contraction and relaxation that protects the lumen from thrombus formation is decreased [5,6]. Thrombus formation is very rare in sinus rhythm, however may still be detected in cases with high risk structural heart disease [7]. It has been reported that, left atrial thrombus formation and subsequent embolisation was less frequent in severe mitral regurgitation (MR), even in cases with AF [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Left atrial appendage functions in patients with severe rheumatic mitral regurgitation

Bitigen

Bulut

Tanalp

et al. 2007

Int J Cardiovasc Imaging

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“…The risk factors previously shown to be associated with left atrial thrombus formation (3) were absent in our patient. Severe aortic insufficiency has been implicated as an associated with a risk for left atrial thrombi in patients with sinus rhythm, due to associated left atrial stasis (3,4), with a RR for systemic embolization of 22.4 (95% CI 2.72 to 184.8) in one study (4); however, all patients in this report had at least mild mitral valve stenosis. Our patient developed acute, severe aortic insufficiency from endocarditis, which caused an acute increase in left ventricular diastolic pressure.…”

Section: Discussionmentioning

confidence: 57%

Left atrial appendage thrombus in a patient in sinus rhythm with endocarditis and a severe aortic valve insufficiency

Shanks¹,

Čujec²,

Choy³

2008

Canadian Journal of Cardiology

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A 66-year-old woman with recently diagnosed monoclonal gammapathy of uncertain significance and no previous cardiac history presented to a tertiary care centre with confusion, aphasia, incontinence and right-sided weakness.One month earlier, she had been admitted to the intensive care unit with a diagnosis of sepsis. At the time, blood cultures had grown Hemophilus influenzae in one of two vials. She received a two-week course of intravenous antibiotics (ampicillin, metronidazole and ciprofloxacin). The source of the bacteremia was never identified. She was on no medications before her current admission.On this presentation, her vital signs included blood pressure of 115/54 mmHg, heart rate of 114 beats/min and O 2 saturation on room air of 99%. Her initial physical examination revealed expressive aphasia, right facial droop and right arm weakness. Her lungs were clear to auscultation. On a precordial examination, her first and second heart sounds were normal, and there was a systolic murmur heard at the left lower sternal border. She had no signs of peripheral edema.Her initial bloodwork showed a white blood cell count of 6.4×10 9 /L (normal value 4×10 9 /L to 11×10 9 /L), hemoglobin 92 g/L (normal value 120 g/L to 160 g/L), mean corpuscular volume 87 L (normal value 80 L to 100 L), platelets 258×10 9 /L (normal value 140×10 9 /L to 450×10 9 /L), international normalized ratio 1.2, partial thromboplastin time 29 s (normal value 24 s to 35 s), urea 11.4 mmol/L (normal value 2.5 mmol/L to 8.0 mmol/L), creatinine 85 μmol/L (normal value 40 μmol/L to 115 μmol/L), magnesium 0.82 mmol/L (normal value 0.7 mmol/L to 1.0 mmol/L) and troponin I 0.61 μg/L (normal value less than 0.15 μg/L).An electrocardiogram showed sinus tachycardia with nonspecific T wave changes in the lateral leads ( Figure 1).Computed tomography of the head confirmed a left middle cerebral artery territory stroke involving primarily the left insular cortex and a portion of the left frontal lobe.The patient was admitted to neurology. She was started on acetylsalicylic acid 325 mg daily, and was given intravenous fluids for dehydration.Within 12 h of presentation, she suddenly developed clinical and radiographic pulmonary edema. She was found to have a loud decrescendo diastolic murmur best heard at the left lower sternal border. Her troponin I level increased to a peak of 0.71 μg/L. Her clinical findings were highly suspicious for aortic valve endocarditis with severe aortic insufficiency and associated congestive heart failure. Due to her clinical deterioration, she was transferred to a cardiology service.Subsequent investigations included a helical computed tomography scan of the lungs, which revealed a filling defect in an anterior segmental branch of the pulmonary artery in the left upper lobe, suspected to be a pulmonary embolus. In addition, a round globular filling defect measuring 1.3 cm × 1.0 cm, which was suspicious for a clot, was identified in the left atrial appendage (LAA). No deep venous thromboses in the legs were seen. The patient wa...

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Clinical and Echocardiographic Characteristics of Patients With Left Atrial Thrombus and Sinus Rhythm

Cited by 99 publications

References 31 publications

Transesophageal Echocardiography Is Superior to Transthoracic Echocardiography in Management of Patients of Any Age With Transient Ischemic Attack or Stroke

Transesophageal Echocardiography Is Superior to Transthoracic Echocardiography in Management of Patients of Any Age With Transient Ischemic Attack or Stroke

Left atrial appendage functions in patients with severe rheumatic mitral regurgitation

Left atrial appendage thrombus in a patient in sinus rhythm with endocarditis and a severe aortic valve insufficiency

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