Key result
AF, larger left atrium, smaller valve area, and low velocities link to left atrial thrombus in MS.
Why the study?
Left atrial appendage clot is a common complication of severe rheumatic mitral stenosis, and its management differs significantly if clot is present.
What echocardiographic and clinical factors are associated with left atrial appendage clot formation in patients with severe rheumatic mitral stenosis?
Observational (n=82)
What echocardiographic and clinical factors are associated with left atrial appendage clot formation in patients with severe rheumatic mitral stenosis?
p-value: p=≤0.05
In patients with severe rheumatic mitral stenosis, atrial fibrillation, larger left atrial size, smaller mitral valve area, and lower flow velocities are significantly associated with left atrial appendage thrombus formation.
May support thrombus risk stratification in rheumatic MS; leaves open prospective validation before guiding practice.
Background: Rheumatic mitral stenosisis still present in the developing world.Left atrial appendage clot is a common complication of mitral stenosis.The management differs significantly if there is presence of clot.Objective: We assessed the factors responsible for left atrial appendage clot formation in patients with severe mitral stenosis through transesophageal echocardiography Methods: An observational study was conducted among 82 (73 females, mean age 35.8±11.8years) patients with severe mitral stenosis who underwent transesophageal echocardiography before percutaneous transmitral commisurotomy.Patients were classified into two groups based on the presence or absence of left atrial thrombus.Group l consisted of 24 patients (women to men ratio 91:9) with left atrial thrombus, while group 2 consisted of 58 patients (women to men ratio 88:12) without left atrial thrombus.Transesophageal echocardiographic findings were reviewed in all patients.Results: There was no significant difference between the two groups in terms of age, sex, systolic pulmonary artery pressure and mitral valve mean pressure gradient (MVMPG), there was significant difference regarding frequency of atrial fibrillation (p≤0.05),left atrial size (p≤ 0.05), mitral valve area andflow velocities (p≤0.05) in group-1 patients.Similarly, atrial fibrillation was observed in 35(42.7%)patients out of which 20(83.3%) patients had thrombus in left atrial appendage.Conclusion: The frequency of left atrial thrombus formation increased in patients with rheumatic mitral stenosis because of low left atrial appendage flow velocities, atrial fibrillation and smaller mitral valve area.
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Bajwa et al. (2016) conducted an observational in Severe rheumatic mitral stenosis (n=82). Left atrial thrombus vs. No left atrial thrombus was evaluated on Factors associated with left atrial thrombus (atrial fibrillation, left atrial size, mitral valve area, and flow velocities) (p=≤0.05). Left atrial thrombus formation in severe rheumatic mitral stenosis was significantly associated with atrial fibrillation, larger left atrial size, smaller mitral valve area, and low flow velocities (p≤0.05).
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