Predictors of Left Atrial Clot and Spontaneous Echogenic Contrast in Patients with Severe Rheumatic Mitral Stenosis: A Prospective Study By Transesophageal Echocardiography
Journal Title: International Journal of Medical Research Professionals - Year 2017, Vol 3, Issue 4
Abstract
Objectives: The objective of this study was to investigate various clinical and echocardiographic variables to predict the left atrial and left atrial appendage clot and spontaneous echo contrast in patients with severe rheumatic mitral stenosis. Materials and Methods: Between 2011 till 2015, 206 patients of rheumatic mitral stenosis comprising of 90 males (mean age 37.2 years) and 116 females (mean age 35.4 year) underwent Transesophageal echocardiography at department of cardiology GMC Jammu. Results: Left atrial clot and spontaneous echo contrast were present in 25.2% and 58% of cases respectively. There were no significant differences in the left ventricular ejection fraction (LVEF) between patients with and without clot. Patients with LA clot were older, had longer duration of symptoms respectively (more frequent atrial fibrillation, larger left atrial area and spontaneous echo contrast) as compared to patients without clot. Similarly, patients with spontaneous echo contrast were older, had more frequent atrial fibrillation left atrial clot, larger left atrial area and diameter and smaller mitral valve area as compared to patients without spontaneous echo contrast. The presence of Mitral Regurgitation has a protective effect against left atrial clot formation. On multiple regression and discriminant function analysis, atrial fibrillation and left atrial area were independent predictors of left atrial clot formation. In a subgroup of patients with sinus rhythm, larger left atrial area and presence of spontaneous echo contrast were significantly associated with the presence of clot in left atrium and left atrial appendage. Conclusion: In patients with severe mitral stenosis, the presence of atrial fibrillation and larger left atrium (>40cm) and spontaneous echo contrast were associated with higher risk of clot formation in the left atrium and might be benefited by prophylactic anticoagulation.
Authors and Affiliations
Sushil Kumar Sharma, Arvind Kohli, Sanjeev Bhat, Vivek Sharma, Nasir Choudhary
Keywords
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- EP ID EP546808
- DOI 10.21276/ijmrp.2017.3.4.029
- Views 64
- Downloads 0
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