Clinical characteristics and outcomes in patients with echocardiographic left ventricular spontaneous echo contrast

https://doi.org/10.1016/j.ijcard.2021.02.005Get rights and content

Highlights

  • We assess the features of left ventricular spontaneous echo contrast (LV-SEC).

  • We reported a high incidence of 1-year embolism in patients with LV-SEC.

  • Age, AF, hemoglobin, LVEF, anticoagulation were associated with 1-year embolism.

  • Improvement in LV function may be helpful for attenuating spontaneous echo contrast.

Abstract

Background

Spontaneous echo contrast (SEC) is a known precursor to thrombus formation and thromboembolic events. This study aims to demonstrate the clinical characteristics and outcomes of patients with left ventricular spontaneous echo contrast (LV-SEC).

Methods

Patients with consecutive echocardiogram performed from October 2009 to September 2019 were enrolled in this retrospective, single-center study. Those with LV-SEC were included, while patients complicated by left ventricular thrombus, with history of infective endocarditis, prosthetic valves, or lost to follow-up were excluded. The clinical endpoint was 1-year thromboembolic events (i.e. stroke and peripheral embolism).

Results

Among 417 patients (mean age 63.5 ± 14.7 years; 86.8% men) with LV-SEC, the incidence of 1-year embolism was 12.9%. In multivariate Cox proportional hazard model, significant risk factors for thromboembolic event were age [hazard ratio (HR) = 1.022, 95% confidence interval (CI): 1.000–1.045], atrial fibrillation (AF) (HR = 2.292, 95% CI: 1.237–4.244), hemoglobin (HR = 1.032, 95% CI: 1.017–1.047), left ventricular ejection fraction (LVEF) (HR = 1.021, 95% CI: 1.002–1.041), and anticoagulant therapy (HR = 0.310, 95% CI: 0.168–0.572). For patients with repeated measurements for echocardiography, D-dimer (HR = 1.137, 95% CI: 1.051–1.231), and LVEF (HR = 0.961, 95% CI: 0.928–0.996) were independently associated with the persistent LV-SEC.

Conclusion

The present study reported a high incidence of 1-year thromboembolic event in patients with LV-SEC. Age, AF, hemoglobin, LVEF were independent risk factors for 1-year embolism and a reduced risk of embolism was observed among patients with anticoagulation therapy. Additionally, D-dimer and LVEF are independently associated with the persistent LV-SEC.

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.

Section snippets

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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  • 1

    Co-first author: Dongjie Liang and Ruiyu Shi.

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