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J Am Coll Cardiol, 2000; 35:1932-1938
© 2000 by the American College of Cardiology Foundation
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CLINICAL STUDIES

Clinical and echocardiographic characteristics of left atrial spontaneous echo contrast in sinus rhythm

Saihari Sadanandan, MDa and Mark V. Sherrid, MD, FACCa

a Division of Cardiology, St. Luke’s-Roosevelt Hospital Center, Columbia University, College of Physicians and Surgeons, New York, New York, USA

Manuscript received July 30, 1999; revised manuscript received December 16, 1999, accepted February 21, 2000.

Reprint requests and correspondence: Dr. Mark V. Sherrid, Division of Cardiology, 3B-30, 1000 Tenth Avenue, New York, New York 10019
msherrid{at}slrhc.org

OBJECTIVES

In this study we attempt to define the clinical and echocardiographic characteristics of patients with left atrial spontaneous echo contrast (LASEC) in sinus rhythm (NSR).

BACKGROUND

Left atrial spontaneous echo contrast in atrial fibrillation (AF) is associated with increased risk of thromboembolism. Little is known about its significance in NSR.

METHODS

We reviewed reports of 1,288 transesophageal echocardiogram (TEE) studies done with a 5 MHz probe. Patients with swirling LASEC who were in NSR during TEE were analyzed. We compared them with a control group of 45 age matched patients selected to have NSR, left atrium (LA) >4.0 cm but no SEC.

RESULTS

Spontaneous echo contrast in NSR was noted in 24 patients (2%) and formed our study group. All patients with SEC had enlarged LA, mean 5.6 cm ± 0.6 cm. There was a higher prevalence of cerebrovascular accident (CVA) in patients with SEC when compared with controls with no SEC, 83% versus 56%, p = 0.02. Patients with SEC had larger LA, 5.6 versus 4.9 cm, p < 0.0001 and lower mean peak left atrial appendage emptying velocity (LAAEV), 38 versus 56 cm/s, p = 0.001. Thirteen percent of patients with SEC had LA thrombus as compared with none in the control group, p = 0.02. By multivariate analysis, SEC in NSR was found to be associated with CVA, larger LA size and decreased mean LAAEV. Even after adjusting for LA size, patients with SEC had a higher prevalence of CVA than controls, p = 0.03.

CONCLUSIONS

Spontaneous echo contrast in NSR occurs in patients with significantly dilated LA and depressed atrial function. Left atrial thrombus is noted in 13% of such patients despite NSR. Spontaneous echo contrast in NSR is associated with a higher prevalence of CVA. Further, SEC is found to be an independent and more powerful correlate of CVA than reduced LAAEV or atrial size. These data indicate that LASEC in NSR is a prothombotic condition.

Abbreviations and Acronyms
  AF = atrial fibrillation
  CHF = congestive heart failure
  CVA = cerebrovascular accident
  LA = left atrium or atrial
  LAA = left atrial appendage
  LAAEV = left atrial appendage emptying velocity
  LASEC = left atrial spontaneous echo contrast
  LV = left ventricle or ventricular
  MR = mitral regurgitation
  NSR = sinus rhythm
  SEC = spontaneous echo contrast
  TEE = transesophageal echocardiogram




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