Left atrial spontaneous echo contrast in mitral valve disease: An indicator for an increased thromboembolic risk

Daniel, Werner G.; Nellessen, U; Schröder, Eberhard; Nonnast-Daniel, B.; Bednarski, Piotr; Nikutta, Peter; Lichtlen, Paul R.

doi:10.1016/0735-1097(88)90283-5

Cited by 492 publications

(144 citation statements)

References 14 publications

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“…1,2,8,11,16,23,24 Li et al 11 evaluated 39 MS patients with SR. They found that the patients with SEC had smaller MVA and higher MG than those without SEC; but LA size, EF, age and gender were similar.…”

Section: Discussionmentioning

confidence: 99%

Annular Systolic Velocity Predicts the Presence of Spontaneous Echo Contrast in Mitral Stenosis Patients with Sinus Rhythm

Çaylı¹,

Acartürk²,

Kanadaşı³

et al. 2007

Clinical Cardiology

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SummaryOjectives: Thromboembolism is the major cause of morbidity and mortality in mitral stenosis (MS), even in sinus rhythm (SR). Spontaneous echo contrast (SEC) is the strongest predictor of thromboembolism. The aim of the study was to investigate if the annular velocities obtained with tissue Doppler imaging can predict the presence of SEC in MS patients with SR.Methods: One hundred and five MS patients and 100 controls were included. Annular velocities were recorded. All patients underwent transesophageal echocardiography. Subjects were divided into three groups as controls (Group I), the patients without SEC (Group II) and the patients with SEC (Group III).Results: Group III patients had lower ejection fraction, annular systolic velocity, smaller mitral valve area, higher transmitral gradient and larger left atrial size. The annular systolic velocity was the only independent predictor for SEC. The cutoff values of annular systolic velocity for prediction of the presence of any SEC and dense SEC were 13.5 and 11.8 cm/s, respectively.Conclusion: The annular systolic velocity is an independent predictor for SEC in MS patients with SR.

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Section: Discussionmentioning

confidence: 99%

Annular Systolic Velocity Predicts the Presence of Spontaneous Echo Contrast in Mitral Stenosis Patients with Sinus Rhythm

Çaylı¹,

Acartürk²,

Kanadaşı³

et al. 2007

Clinical Cardiology

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“…The degree of spontaneous echocontrast was graded according the following criteria: mild was defined as minimal echogenicity located in the LAA or sparsely distributed in the main cavity of the left atrium, which was possible to detect only transiently during the cardiac cycle, but imperceptible at operating gain settings for two-dimensional echochardiographic analysis. "Moderate" was defined as a dens, swirling pattern in the LAA, generally associated with somewhat lesser intensity in the main cavity, which may fluctuate in intensity but detectable constantly through the cardiac cycle "Severe" was defined as an intense, echo density and a very slow swirling pattern in the LAA, usually with similar density in the main cavity (Daniel et al 1988).…”

Section: Echocardiographymentioning

confidence: 99%

Left Atrial Appendage-Flow Velocity Predicts Cardioversion Success in Atrial Fibrillation

Akdeniz

Badak

Barış

et al. 2006

Tohoku J. Exp. Med.

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Restoration of sinus rhythm by electrical cardioversion is a therapeutic option in appropriately selected patients with atrial fibrillation. It is important to determine predictors of electrical cardioversion outcome in patients with atrial fibrillation. Predictive value of clinical and conventional echocardiographic parameters for predicting cardioversion outcome is limited. The role of left atrial appendage (LAA) function, which may reflect left atrial contractile function, for prediction of cardioversion outcome remains unclear. We conducted a single center prospective study to evaluate the role of LAA function for prediction of cardioversion success in patients with atrial fibrillation. One hundred sixty three patients with atrial fibrillation underwent transthoracic and transesophageal echocardiography (TEE) before electrical cardioversion. LAA functions, including LAA peak flow velocity, LAA area and LAA ejection fraction, were examined. Cardioversion was successful in 133 patients and unsuccessful in 30 patients. Mean LAA peak emptying flow velocity was significantly higher in the patients with successful cardioversion than in those with unsuccessful cardioversion (0.34 ± 0.14 vs 0.27 ± 0.1 m/sec; p = 0.013). At multivariate logistic regression analysis, only LAA flow velocity (> 0.28 m/sec, odds ratio = 2.8 ; p = 0.03) proved to be an independent predictor of cardioversion success. LAA area ( p = 0.18) and LAA ejection fraction ( p = 0.52) were not different between successful and unsuccessful cardioversion groups. Therefore, measurement of LAA flow velocity provides valuable information for prediction of cardioversion outcome in patients with atrial fibrillation before TEE guided cardioversion.cardioversion; left atrial appendage (LAA) function; atrial fibrillation

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“…6,7) Doppler TEE measurements of blood flow velocity in the LA appendage (LAA) and the presence of LA spontaneous echocardiographic contrast (LASEC) have been used to assess the severity of blood stasis, a risk factor for thrombus formation and stroke. 7,8) Previous reports have shown that dense LASEC, decreased LAA flow velocity, and complex aortic plaques on TEE are independent risk factors for subsequent thromboembolic events. [9][10][11] In fact, Takashima, et al reported that these TEE findings were stronger predictors of ischemic stroke than the CHADS2 score in patients with NVAF.…”

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confidence: 99%

Blood Stasis Secondary to Heart Failure Forms Warfarin-Resistant Left Atrial Thrombus

Watanabe

Yamashita

2014

Int. Heart J.

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SummaryAnticoagulants such as warfarin are recommended for patients with atrial fibrillation (AF) to decrease stroke risk associated with thrombus formation in the left atrium (LA). In a subgroup of patients, however, warfarin is unable to prevent LA thrombus formation at therapeutic doses. This study characterized the clinical and echocardiographic features of patients having warfarin-resistant LA thrombus.Of the 1364 nonvalvular AF patients examined by transesophageal echocardiography, 431 received warfarin. A total of 10 patients (2.3% of warfarin-treated patients) exhibited LA thrombus formation even during warfarin treatment at a dose and duration sufficient for increasing the prothrombin time-international normalized ratio (PT-INR) to the therapeutic range for ≥ 30 days. Categorical regression analysis revealed that decreased LA appendage (LAA) flow velocity, greater LA spontaneous echocardiographic contrast (LASEC), and lower left ventricular ejection fraction (LVEF) significantly contributed to residual LA thrombus (P < 0.05 for all). Receiver operating characteristic (ROC) curve analysis indicated that higher right ventricular systolic pressure, which suggests LA pressure (area under curve, 0.85), LV mass index (0.81), and LA dimension (0.68), as well as lower LAA flow velocity (0.92) and LVEF (0.91) predicted warfarinresistant LA thrombus formation (all P < 0.05).These results suggest that blood stasis secondary to heart failure contributes to the formation of warfarin-resistant LA thrombus. We propose that therapies to increase LVEF should be administered together with warfarin for AF patients with heart failure to decrease stroke risk. (Int Heart J 2014; 55: 506-511)

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Left atrial spontaneous echo contrast in mitral valve disease: An indicator for an increased thromboembolic risk

Cited by 492 publications

References 14 publications

Annular Systolic Velocity Predicts the Presence of Spontaneous Echo Contrast in Mitral Stenosis Patients with Sinus Rhythm

Annular Systolic Velocity Predicts the Presence of Spontaneous Echo Contrast in Mitral Stenosis Patients with Sinus Rhythm

Left Atrial Appendage-Flow Velocity Predicts Cardioversion Success in Atrial Fibrillation

Blood Stasis Secondary to Heart Failure Forms Warfarin-Resistant Left Atrial Thrombus

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