This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sadanandan, S. Articles by Sherrid, M. V. Search for Related Content PubMed PubMed Citation Articles by Sadanandan, S. Articles by Sherrid, M. V.

CLINICAL STUDIES

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

^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

This article has been cited by other articles:

				S. Uretsky, A. Shah, S. Bangalore, L. Rosenberg, R. Sarji, D. R. Cantales, D. Macmillan-Marotti, F. A. Chaudhry, and M. V. Sherrid Assessment of left atrial appendage function with transthoracic tissue Doppler echocardiography Eur J Echocardiogr, May 1, 2009; 10(3): 363 - 371. [Abstract] [Full Text] [PDF]

				M. A. McDonald, Y. Fu, U. Zeymer, G. Wagner, S. G. Goodman, A. Ross, C. B. Granger, F. Van de Werf, P. W. Armstrong, and for the ASSENT-4 PCI Investigators Adverse outcomes in fibrinolytic-based facilitated percutaneous coronary intervention: insights from the ASSENT-4 PCI electrocardiographic substudy Eur. Heart J., April 1, 2008; 29(7): 871 - 879. [Abstract] [Full Text] [PDF]

				A. Harloff, M. Handke, M. Reinhard, A. Geibel, and A. Hetzel Therapeutic Strategies After Examination by Transesophageal Echocardiography in 503 Patients With Ischemic Stroke Stroke, March 1, 2006; 37(3): 859 - 864. [Abstract] [Full Text] [PDF]

				Y.-C. Wang, J.-L. Lin, J.-J. Hwang, M.-S. Lin, C.-D. Tseng, S. K. S. Huang, and L.-P. Lai Left Atrial Dysfunction in Patients With Atrial Fibrillation After Successful Rhythm Control for > 3 Months Chest, October 1, 2005; 128(4): 2551 - 2556. [Abstract] [Full Text] [PDF]

				J.-F. Ren, F. E. Marchlinski, and D. J. Callans Left atrial thrombus associated with ablation for atrial fibrillation: identification with intracardiac echocardiography J. Am. Coll. Cardiol., May 19, 2004; 43(10): 1861 - 1867. [Abstract] [Full Text] [PDF]

				M. Takami, M. Suzuki, K. Sugi, and T. Ikeda Time course for resolution of left atrial appendage stunning after catheter ablation of chronic atrial flutter J. Am. Coll. Cardiol., June 18, 2003; 41(12): 2207 - 2211. [Abstract] [Full Text] [PDF]

				R. Rastegar, D. J. Harnick, P. Weidemann, V. Fuster, B. Coller, J. J. Badimon, J. Chesebro, and M. E. Goldman Spontaneous echo contrast videodensity isflow-related and is dependent on the relative concentrations of fibrinogen and red blood cells J. Am. Coll. Cardiol., February 19, 2003; 41(4): 603 - 610. [Abstract] [Full Text] [PDF]

				Y. Agmon, B. K. Khandheria, F. Gentile, and J. B. Seward Clinical and Echocardiographic Characteristics of Patients With Left Atrial Thrombus and Sinus Rhythm: Experience in 20 643 Consecutive Transesophageal Echocardiographic Examinations Circulation, January 1, 2002; 105(1): 27 - 31. [Abstract] [Full Text] [PDF]