Which Patients with Dilated Cardiomyopathy Have Left Atrial Spontaneous Echo Contrast?

OBJECTIVES
Left atrial spontaneous echo contrast (LA-SEC) detected by transesophageal echocardiography (TEE) is a strong predictor for thromboembolic events. Few studies investigated the related conditions that lead to appearance of LA- SEC in dilated cardiomyopathy (DCMP) patients. The aim of the study was to investigate the prevalence of LA-SEC in patients with DCMP and to determine its related parameters.
METHODS
Consecutive patients (29 female, 65 male, mean age 60±11 years) with the diagnosis of ischemic (n=56) and non-ischemic (n=38) DCMP underwent laboratory, transthoracic and TEE examination.
RESULTS
LA-SEC was established in 48 patients (51%) of study group. LA-SEC was detected in 33 (59%) of ischemic DCMP and 15 (39%) of non- ischemic patients. In ischemic DCMP, restrictive diastolic filling (RDF) was observed 36% of the patients with LA- SEC vs. 22% in the patients without LA-SEC (p=0.05). Atrial fibrillation (AF) was present in 42% vs. 17% (p=0.05), hypertension was present 67% vs 39% of the patients respectively. In patients with ischemic DCMP, another significant correlate of LA-SEC was high fibrinogen level (471±78 mg/dl vs. 392±83 mg/dl, p=0.003). In non-ischemic DCMP group, AF was observed in 53% of the patients with LA-SEC vs. in 13% of the patients without LA-SEC (p=0.01). In patients with non- ischemic DCMP other significant determinants for LA-SEC were increased age (65±6 years vs. 53±12 years, p< 0.001), decreased cardiac index (2.1±0.6 L/min/m2 vs. 2.7±0.6 L/min/m2, p= 0.009) and reduced left atrial appendage velocities (p<0.001).
CONCLUSIONS
In patients with DCMP, LA-SEC is frequently detected in patients with AF. In ischemic DCMP frequency of RDF and hypertension, and high fibrinogen level, in non-ischemic DCMP increased age and low cardiac index appeared as other correlates of LA-SEC.