spontaneous echo contrast
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2021 ◽  
Vol 8 ◽  
Author(s):  
Zhitong Li ◽  
Quanbo Liu ◽  
Fei Liu ◽  
Tesfaldet H. Hidru ◽  
Yuqi Tang ◽  
...  

Background: The predictive power of the CHADS2 and CHA2DS2-VASc scores for the presence of Left atrial thrombus (LAT)/ spontaneous echo contrast (SEC) in non-valvular atrial fibrillation (NVAF) is modest. The aim of this analysis is to define clinical and ultrasonic variables associated with LAT/SEC and to propose nomograms for individual risk prediction.Methods: Data on 1,813 consecutive NVAF patients who underwent transesophageal echocardiography (TEE) from January 2016 to January 2021 were collected. The univariate and multivariate logistic regression analyses were used to construct a nomogram. We examined the predictive ability of the risk scores by calculating the area under the curve (AUC). Moreover, the performance of the nomogram was assessed with respect to calibration, discrimination, and clinical usefulness.Results: LAT/SEC was found in 260 (21.0%) and 124 (21.6%) patients in the training and validation cohorts, respectively. On multivariate analysis, independent factors for LAT/SEC were Age, left atrial diameter (LAD), left ventricular ejection fraction (LVEF), hypertension (HTN), previous stroke or transient ischemic attack, Non-paroxysmal AF and a nomogram was built based on these variables. The calibration curve for the probability of LAT/SEC showed good prediction agreement with actual observation. The nomogram achieved good concordance indexes of 0.836 and 0.794 in predicting LAT/SEC in the training and validation cohorts, respectively. Decision curve analysis demonstrated that the nomogram would be clinically useful.Conclusions: In this study, a nomogram was constructed that incorporated six characteristics of NVAF patients. The nomogram may be of great value for the prediction of LAT/SEC in NVAF patients.


2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
F Wegner ◽  
R Radke ◽  
C Ellermann ◽  
J Wolfes ◽  
A.J Fischer ◽  
...  

Abstract Introduction Transoesophageal echocardiography (TOE) is routinely performed before catheter ablation of atrial tachyarrhythmias to rule out the presence of possible left atrial thrombi. However, data to support this practice are scarce. Methods We analysed consecutive pre-procedural TOE in a high-volume electrophysiology centre for the presence of left atrial thrombi and a relevant flow reduction in the left atrial appendage (LAA) defined as LAA sludge or pronounced spontaneous echo contrast. Possible predictors of reduced flow were recorded and compared in a multivariate logistic regression analysis. Results 1676 consecutive TOE were included (1122 before pulmonary vein isolation (PVI), 436 before atrial flutter ablation, 166 before other EP studies in patients with a history of atrial tachyarrhythmias). 543 patients (32%) were female, mean age was 63±12 years and BMI was 27±5 kg/m2. Nine patients (0.5%) had an LAA thrombus on pre-procedural TOE. Ninety-five further patients (5.7%) had a relevant reduction in LAA flow as characterized by LAA sludge or spontaneous echo contrast. Further patient characteristics by LAA flow state are shown in the table. While a higher CHA2DS2-VaSc-Score was associated with the presence of LAA sludge and LAA thrombus (p=0.01), no further clinical parameters such as choice of oral anticoagulation agent were independently predictive of reduced flow velocities or thrombus in a logistic regression model (see table). Importantly, LAA thrombi also occurred in patients with a CHA2DS2-VaSc-Score ≤1 (n=1) or in sinus rhythm (n=2). Of note, 6 out of 9 patients with a LAA thrombus were anticoagulated with phenprocoumon. Conclusion LAA thrombus is a rare occurrence before an elective catheter ablation. In patients with CHA2DS2-VaSc-Score ≤1 the likelihood of LAA thrombus is so low (0.2%) that it may be considered to give up routine TOE before an EP study/ablation. FUNDunding Acknowledgement Type of funding sources: None.


2021 ◽  
pp. 1-10
Author(s):  
Kosuke Matsuzono ◽  
Masayuki Suzuki ◽  
Kumiko Miura ◽  
Tadashi Ozawa ◽  
Takafumi Mashiko ◽  
...  

Background: Many issues persist in the today’s Alzheimer’s disease (AD) screening and the breakthrough method is desired. Objective: We aim to validate the association between venous reflux and AD, and to develop a new method for AD screening. Methods: We examined spontaneous echo contrast, area, diameter, retrograde velocity, and anterograde velocity of the bilateral cervical internal jugular vein (IJV) using carotid ultrasonography. Results: A total of 112 patients participated in this study, with 26 diagnosed as AD. The proportion of both or either IJV spontaneous echo contrast (+) occupied 25 of total 26 AD patients, which showed 96.2%of sensitivity and 98.5%negative predictive value. The IJV velocities also showed significant correlation with AD diagnosis, although the IJV area or diameter did not. Conclusion: Our results indicate that the validation of the spontaneous echo contrast or velocities of the IJV are convenient AD diagnosis screening methods and that the venous reflux disturbance correlates with AD development.


Author(s):  
Ziya Bilgel ◽  
Hakan gullu ◽  
Saif Hamad ◽  
Mutlu Kasar ◽  
Tansel Erol ◽  
...  

Backround: Spontaneous echo contrast (SEC) is an echocardiographic finding particularly found in left atrium of patients with mitral stenosis (MS) and known as a risk factor for stroke. However, its pathophysiology is not fully understood. Methods: Forty-eight patients with MS scheduled for percutaneous mitral valvuloplasty were included in the study. Blood samples were taken from the aorta and left atrium (LA) during the procedure. Whole blood viscosity (WBV), plasma viscosity (PV) and peripheral blood smears were obtained and analysed separately from these sites. All participants underwent transthoracic and transesophageal echocardiography prior to the procedure Results: Severe SEC (grade 3-4) was found in 23 patients, remaining 25 patients had mild to moderate SEC (grade 0-1-2). Patients with severe SEC had increased LA diameter, area and PV. However, ejection fraction, left atrial appendage (LAA) filling and emptying velocities, LAA lateral wall late systolic velocity, LAA fractional area change and pulmonary vein (PVe) systolic velocity were found to be significantly reduced in patients with severe SEC compared to mild to moderate SEC. On multiple linear regression analysis, atrial fibrillation, left atrium PV and diameter were strongly correlated with SEC grade (Respectively p=0,011, p=0,013, p=0,030). Conclusion: We have shown that AF, systolic dysfunction of LAA and left ventricule, reduced PVe flow velocity, increased LA dimensions and left atrial PV were related with the severity of SEC in patients with mitral stenosis. We demonstrated the relationship between the increase left atrial PV and SEC in addition to impaired hemodynamic determinants in patients with mitral stenosis.


2021 ◽  
Vol 8 ◽  
Author(s):  
Binhao Wang ◽  
Zhao Wang ◽  
Guohua Fu ◽  
Bin He ◽  
Hangxuan Wang ◽  
...  

Objectives: Spontaneous echo contrast (SEC) in the left atrium (LA) is frequently observed in atrial fibrillation (AF) patients and may lead to thromboembolic events. We aimed to investigate both periprocedural and long-term stroke risks associated with LA SEC in AF patients undergoing percutaneous left atrial appendage closure (LAAC).Methods: A total of 408 consecutive AF patients treated with LAAC between March 2015 and February 2019 were divided into two groups based on preprocedural transesophageal echocardiography: the study group (moderate/severe LA SEC; n = 41) and the control group (none, mild, or mild to moderate LA SEC; n = 367). To attenuate the observed imbalance in baseline covariates, a propensity score matching technique was used.Results: No periprocedural stroke/transient ischemic attack (TIA) was documented. The incidence of device-related thrombus was higher in the study group than in the control group (8.8 vs. 1.3%; P = 0.025). The mean follow-up period was 3.2 ± 1.1 years, during which 8 patients (2.2%) in the control group and 4 (9.8%) in the study group experienced stroke/TIA (P = 0.024). Moderate/severe LA SEC was identified as an independent predictor of stroke/TIA in both the original population (HR = 5.71, 95% CI 1.47–22.19, P = 0.012) and the matched population (HR = 9.79, 95% CI 1.44–66.86, P = 0.020).Conclusions: LA SEC did not show a relationship with periprocedural stroke events in patients undergoing percutaneous LAAC. However, moderate/severe LA SEC increased the incidence of device-related thrombus and the risk of late stroke/TIA.


Author(s):  
Julian Felix Backhaus ◽  
Andreas Pflaumbaum ◽  
Christos Krogias ◽  
Fabienne Kreimer ◽  
Andreas Mügge ◽  
...  

Abstract Background Thrombi and spontaneous echo contrast (SEC) in the left atrial appendage (LAA) are associated with thromboembolic events and poor prognosis. There are very few data on long-term outcome, especially with the use of direct acting anticoagulants (DOAC). Methods In this retrospective study, all transoesophageal echocardiographies performed at a tertiary care university hospital from 2015 to 2020 were analyzed. All patients with thrombus or SEC in the LAA were included. Medical history, laboratory, echocardiographic parameters and medication at discharge were documented. The primary endpoint of the study was a composite endpoint (all-cause mortality, non-fatal stroke or transient ischaemic attack [TIA], non-fatal systemic embolization, non-fatal major bleeding and non-fatal myocardial infarction). Results Of a total of 4062 transoesophageal echocardiographies, thrombi were detected in 51 patients (1.2%) and SEC in 251 patients (6.2%). These patients formed the final study cohort (n = 302). During a mean follow-up period of 956 ± 663 days, 87 patients (29%) suffered the primary point. The following baseline characteristics predicted the primary endpoint: age, haemoglobin, a previous coronary artery bypass grafting, dialysis and choice of anticoagulation. Prescription of apixaban at discharge was associated with lower rate of adverse events (hazard ratio 0.564, confidence interval 0.331–0.960; p = 0.035) while prescription of dabigatran was associated with higher rate of adverse events (hazard ratio 3.091, confidence interval 1.506–6.347; p = 0.002). Conclusion Even in the DOAC era, the occurrence of thrombus or SEC in the LAA is associated with a high rate of MACCE. Our study suggests that the choice of DOAC therapy may have an impact on long-term survival. Graphic abstract


2021 ◽  
pp. 112972982110355
Author(s):  
Sertan Özyalçın ◽  
Hülya Topçu

Background: Spontaneous echo contrast (SEC) is an ultrasonographic image of swirling blood flow resembling a dynamic, cigarette smoke-like image. It is mostly observed during the insertion of tunneled dialysis catheters (TDC) into internal jugular veins with ultrasound guidance, often different levels of SEC can be seen. The aim of this study is to investigate the impact of SEC detected during TDC insertion on the patency of the catheter. Methods: Patients who had a TDC insertion in our clinic between January 2015 and December 2020 were prospectively evaluated. The patients were grouped into five groups according to the sec level and followed. Results: A total of 226 patients were examined, among which 107 were male (47.3%). The mean age of all patients was 63.1 ± 9.5 years. SEC grade and catheter occlusion was evaluated, it was observed that higher SEC grades were correlated with faster catheter thrombosis postinsertion. During the follow-up period, it was found that, compared to the SEC 0 group, catheter thrombosis occurred 3.22 times faster in the SEC 1 group, 2.66 times faster in the SEC 2 group, 5.80 times faster in the SEC 3 group, and 26.33 times faster in the SEC 4 group. (HR: 3.22, 2.66, 5.80, 26.33, respectively). Hematological parameters were evaluated by regression analysis, it was observed that hemoglobin, fibrinogen, and platelet count were not risk factors for SEC formation and SEC grade. Conclusion: Significant relationship was found between SEC grade detected during catheter insertion and catheter thrombosis in patients undergoing hemodialysis with a TDC.


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