January 1, 1997Open Access

Thromboembolism Risk in Patients with Mitral Stenosis.

EAEsmeray AcartürkCukurova University AUAyhan UsalCukurova University MDMesut DemirDicle University

Structured PICO

Does left atrial spontaneous echo contrast (SEC) detected by echocardiography predict thromboembolic risk in patients with rheumatic mitral stenosis?

Population

168 consecutive patients with predominant rheumatic mitral stenosis

Intervention

Transthoracic (TTE) and transesophageal echocardiography (TEE) to assess left atrial spontaneous echo contrast (SEC) and thrombus

Comparator

Patients without previous embolic events

Outcome

Association of echocardiographic and clinical parameters (left atrial SEC, thrombus, atrial fibrillation, left atrial size, mitral valve area) with previous embolic eventshard clinical

Left atrial spontaneous echo contrast detected by TEE is a major determinant of thromboembolic risk in rheumatic mitral stenosis, independent of rhythm and atrial size, and can help guide appropriate therapy.

Abstract

A total of 168 consecutive patients with predominant rheumatic mitral stenosis were evaluated by transthoracic (TTE) and transesophageal echocardiography (TEE). Of the 168 patients, 35 had previous embolic events (group I) and 133 had no emboli (group II). A total of 77 (45.8%) patients had atrial fibrillation. The frequency of atrial fibrillation was higher in group I than group II (68.6% vs 39.8%, p < 0.001). The incidence of left atrial enlargement was greater in group I (p < 0.001). Mitral valve area was found to be smaller in group I compared to group II (p < 0.001). In group I 83.3% and 29.2% of the patients with atrial fibrillation had left atrial spontaneous echo contrast (SEC) and left atrial thrombus, respectively, and 72.7% of the patients with sinus rhythm had left atrial SEC. In group II 79.2% and 20.8% of the patients with atrial fibrillation had left atrial SEC and left atrial thrombus whereas 28.6% and 2.6% of the patients with sinus rhythm had left atrial SEC and left atrial thrombus, respectively. The incidence of left atrial thrombus was significantly different in those patients with compared to those without embolic events (20% vs 9.7%, p < 0.01). In groups I and II, 28 of 35 (80%) and 64 of 133 (48.1%) patients had left atrial SEC (p < 0.01). Patients with left atrial SEC had a greater left atrial size (p < 0.01) and smaller mitral valve area (p < 0.01). Left atrial size was normal in 2 patients with left atrial SEC and SEC was not found in 55 patients with enlarged left atrium. Multiple logistic regression analysis showed that atrial fibrillation, mitral valve area and left atrial enlargement were independent predictors of the SEC (p < 0.001) and left atrial SEC was the principal determinant of thromboembolism. These data suggest that regardless of rhythm and atrial size, left atrial SEC is a principal determinant of thromboembolic risk in mitral stenosis. TEE may be able to detect those patients with mitral stenosis at risk for emboli and guide appropriate therapy.

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