Chest
Volume 108, Issue 1, July 1995, Pages 99-103
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Clinical Investigations
Left Atrial Spontaneous Echo Contrast in Patients With Rheumatic Mitral Valve Disease in Sinus Rhythm: Implication of an Altered Left Atrial Appendage Function in Its Formation

https://doi.org/10.1378/chest.108.1.99Get rights and content

Thirty-nine patients who had rheumatic mitral valve disease in sinus rhythm were studied to compare echocardiographic and hemodynamic characteristics between those with and without left atrial (LA) spontaneous echo contrast. Patients were divided into two groups according to the presence (group 1, n=17) or absence (group 2, n=22) of the echo contrast. Transthoracic echocardiography and transesophageal echocardiography were performed in all patients within 1 week of cardiac catheterization study. Group 1 patients (5 men and 12 women; mean age, 47.7 ± 13.1 years) showed smaller mitral valve area, greater transmitral valve pressure gradient, and absence of moderate to severe mitral regurgitation compared with group 2 patients (7 men and 15 women; mean age, 47.8 ± 14.3 years). There was no significant difference in LA dimension, left ventricular end-systolic and end-diastolic dimensions, or in left ventricular ejection fraction between the two groups of patients. Left atrial appendage function was studied with Doppler in 26 patients. Patients (n=10) with LA spontaneous echo contrast had significantly lower LA appendage ejection fraction (20.34 ± 10.76% vs 34.16 ± 13.13%; p<0.05) and lower LA appendage peak emptying velocity (0.17 ± 0.09 m/s vs 0.27 ± 0.12 m/s; p<0.05) than those (n=16) without echo contrast. It is concluded that obstruction to mitral flow and altered LA appendage contractile function, not the LA size, are likely to be more important factors for the development of LA and LA appendage spontaneous echo contrast in patients with rheumatic mitral valve disease (predominant mitral stenosis) who are in sinus rhythm. These findings further substantiate that blood stasis in the LA cavity and the LA appendage is the mechanism fundamental to the formation of such spontaneous echo contrast.

Section snippets

Study Patients

A total of 39 patients with rheumatic mitral valve disease in sinus rhythm who were admitted to the National Taiwan University Hospital from January to December 1993 were enrolled in this study. Their diagnosis of rheumatic mitral valve disease was based on clinical, electrocardiographic, roentgenologic, and echocardiographic examinations. All patients underwent cardiac catheterization studies. Four patients had undergone xenograft replacement at the mitral position and had developed xenograft

Clinical, Echocardiographic, and Hemodynamic Characteristics

The LA spontaneous echo contrast was detected in 17 (43.6%) of the 39 patients with rheumatic mitral valve disease in sinus rhythm by transesophageal echocardiography; none was detected by transthoracic echocardiography (p<0.001). All the spontaneous echo contrasts were present concomitantly in the LA and in the LA appendage. No spontaneous echo contrast in the LA appendage alone was observed. Of the 17 patients with spontaneous echo contrast (group 1), 2 were found also to have LA thrombus;

Discussion

The present transesophageal echocardiographic study found LA spontaneous echo contrast in 43.6% of 39 patients with rheumatic mitral valve disease in sinus rhythm. This incidence was lower than in patients who had similar mitral valve lesions, but in atrial fibrillation (32 of 36 patients, 88%) as previously reported from this country.10 Interestingly, however, the spontaneous echo contrast in these patients was found concomitantly in the LA cavity and in the LA appendage; two of those with

Acknowledgment

The authors thank Miss Mei-Huei Feng and Miss Yu-Hui Liu for their continuing help in the echocardiography laboratory.

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This study was supported by the following grants: NSC 82-0115-B002-481 from National Science Council, Executive Yuan, ROC, and NTUH-84212-B34 from the National Taiwan University Hospital.

Manuscript revision accepted November 14.

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