Right atrial spontaneous echo contrast indicates a high incidence of perfusion defects in pulmonary scintigraphy in patients with atrial fibrillation

Abstract

This study investigated the relationship between right atrial SEC (RA-SEC) and silent pulmonary embolism (PE) in patients with nonvalvular atrial fibrillation (NVAF). Spontaneous echo contrast (SEC) within the cardiac chambers is associated with an increased risk of thromboembolism. However, most studies have examined the relationship between left atrial SEC and systemic thromboembolic disease. Transesophageal echocardiography (TEE) was performed in 210 patients with NVAF to assess a risk of thromboembolism. Right atrial SEC was detected in 37 patients, and 35 of these patients with RA-SEC and 29 patients without RA-SEC were enrolled in this study. However, patients with a history of symptomatic PE or deep vein thrombosis were excluded. Spontaneous echo contrast was diagnosed by TEE as the presence of smoke-like echoes that swirled in a circular pattern. PE was diagnosed by pulmonary scintigraphy. Thrombotic and thrombolytic parameters, including serum concentrations of plasmin-alpha-plasmin inhibitor complex (PIC), thrombin-antithrombin complex (TAT), D-dimer, and fibrinogen were measured in all patients. Left ventricular dimension, cardiac function, and hematologic parameters were similar in the two groups. Nevertheless, the incidence of perfusion defects in pulmonary scintigraphy was significantly higher in the group with RA-SEC (40%) than in the group without RA-SEC (7%; chi-square, P=0.006). The increased incidence of perfusion defects in pulmonary scintigraphy in patients with RA-SEC indicates that right atrial SEC may be a predictable factor at a high risk of PE.

Asymptomatic Pulmonary Embolism after Ablation

“…In patients with right atrial spontaneous echo contrast, silent PE was investigated by using pulmonary scintigraphy [17]. Symptomatic PE and DVT data were not reported, but pulmonary perfusion defects were reported to be significantly increased in patients with spontaneous echo contrast in the RA group versus the controls [17]. In our study, the incidence of asymptomatic PE was 14.1% according to the first observer and 8.5% according to the second observer.…”

“…During random screening of thorax CT scans performed for reasons other than suspected PE, incidental PE was found in 2.6% of hospitalizations per se, and antecedent cancers were reported as the most important risk factors [9]. In patients with right atrial spontaneous echo contrast, silent PE was investigated by using pulmonary scintigraphy [17]. Symptomatic PE and DVT data were not reported, but pulmonary perfusion defects were reported to be significantly increased in patients with spontaneous echo contrast in the RA group versus the controls [17].…”

Large right atrial clot presenting as acute pulmonary thromboembolism in a case of rheumatic mitral stenosis after PTMC

“…A recent study on AF patients has confirmed that PTE is associated with spontaneous echocardiographic contrast in right atria. 7 The pathogenesis of PTE is multifactorial in such cases. Abnormalities of pulmonary vessel wall and blood constituents may contribute to the formation of PTE.…”

Abrupt formation and spontaneous resolution of a right atrial thrombus detected by intraoperative transesophageal echocardiography during replacement of an abdominal aortic aneurysm

“…Actually, we almost continuously monitored TEE for evaluation of a right atrial thrombus and early detection of pulmonary thromboembolism but did not observe resolution of a right atrial thrombus. Spontaneous echogenic contrast, keyimage, representing gradual breaking down of a right atrial thrombus, might be helpful to discriminate between its abrupt disappearance and its gradual breaking down, and to count the time from its appearance to its disappearance [18], but unfortunately could not be obtained. The size of the cardiac chamber was in the normal range and not changed before and after abrupt formation and spontaneous resolution of the right atrial thrombus.…”