Clinical characteristics and outcomes in patients with echocardiographic left ventricular spontaneous echo contrast
Introduction
Spontaneous echo contrast (SEC) is a smoke-like echo density seen in an echocardiogram and indicates blood stasis in cardiac chambers [1]. This echocardiographic phenomenon has been known as a precursor of thrombus formation and mark of thromboembolic risk [2,3]. SEC is commonly observed in patients with mitral stenosis [2], atrial fibrillation [4], cardiomyopathy [5], and heart failure [6]. Increasing evidence demonstrated that left atrial SEC is highly correlated with increased risk of thromboembolism [[7], [8], [9]]. However, there is paucity of information on the clinical characteristics and significance of left ventricular spontaneous echo contrast (LV-SEC). Risk stratification for thromboembolism in patients with LV-SEC can serve to identify subgroups of patients who may potentially benefit from earlier intervention, and to ultimately reduce the social and economic burden related to embolic events. Thus, the present study was designed to examine the clinical and echocardiographic characteristics of patients with LV-SEC and to identify risk factors for 1-year thromboembolic events in those patients.
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Study design and population
This is a retrospective, single-center study assessing the 730,128 consecutive echocardiogram reports performed at the First Affiliated Hospital of Wenzhou Medical University from October 2009 to September 2019. A total of 485 patients with a reported LV-SEC, regardless of the underlying disease, were screened. Patients with prosthetic valves (n = 18), history of infective endocarditis (n = 5), or complicated by LV thrombus (n = 23) or lost to follow-up (n = 22) were excluded. Finally, a total
Baseline characteristics of the patients
Of the 730,128 echocardiograms performed during the study period, a total of 485 patients had a reported LV-SEC, while 417 patients were included in the final analysis after exclusion criteria. Of those, 217 patients had repeated measurements for echocardiography. Baseline characteristics of the overall population stratified by presence of thromboembolic event is described in Table 1. The mean age of the population was 63.5 ± 14.7 years and the incidence of 1-year thromboembolic event was 12.9%
Discussion
To the best of our knowledge, this is the first real-world study to explore the clinical characteristics and embolism risk factors in a retrospective cohort of 417 patients with LV-SEC. The major findings of the present study were (1) in patients with LV-SEC, the incidence of 1-year thromboembolic event was 12.9%; (2) the independent predictors for 1-year thromboembolic event were age, history of AF, hemoglobin, LVEF and anticoagulant therapy; (3) Among the patients with repeated measurements
Conclusions
In the present retrospective study, we demonstrated a high incidence rate of 1-year thromboembolic event among patients with LV-SEC. Age, AF, hemoglobin, LVEF were independent risk factors for 1-year thromboembolic event and appropriate anticoagulation therapy may decrease the incidence of embolic events in these patients. In addition, D-dimer and △LVEF are independently associated with the persistent LV-SEC. Improvement of LV function may be helpful for attenuating SEC.
Declaration of Competing Interest
None.
Acknowledgements
This study was supported by the National Natural Science Foundation of China (81600341), the Natural Science Foundation of Zhejiang Province (LQ15H020005), and Wenzhou Science Technology Bureau Foundation (Y20190616).
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Cited by (1)
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Co-first author: Dongjie Liang and Ruiyu Shi.
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