1021-56 Prevalence of Fibrin Strands at Transesophageal Echocardiography

Abstract

Fibrin strands (FS) shown by transesophageal echocardiography (TEE) on the left heart valves have been associated with an increased risk of stroke and systemic embolism. However, some have argued that FS merely represent degenerative valve changes due to stress or aging. The prevalence of FS in patients with structurally normal or abnormal hearts is unknown, To determine the prevalence of FS, we reviewed multiplane TEE from 100 patients. Group 1 consisted of 50 consecutive patients referred with various diagnoses for TEE (23 M, 27 W, ages 18 to 79, mean 50 y). Group 2 consisted of another 50 consecutive patients in sinus rhythm with structurally normal hearts at TEE (28 M, 22 F, ages 17 to 76, mean 42 y). In Group 1, 3 of 20 patients (15%) evaluated for cardiac source of embolism showed FS, while 2 of 30 patients (7%) evaluated for other reasons showed FS. FS were seen on the mitral valve in 3 patients and on the aortic valve in 2 patients. Three (3) of the 5 valves with FS were structurally normal, while 2 were thickened. In Group 2 (patients with normal hearts by TEE), 9 of 27 patients (33%) evaluated for cardiac source of embolism showed FS, while only 1 of 23 patients (4%) evaluated for other reasons showed FS. FS were seen on the mitral valve in nine patients, while 1 patient had both mitral and aortic valve FS. Of 47 patients in both groups with a history of systemic embolism, 12 (25%) had FS. Of the remaining 53 patients referred for other reasons, 3 16%) had FS. (p < 0.01). FS are frequently found at TEE in patients with a history of systemic embolism-even in structurally normal hearts. FS are an infrequent TEE finding in the absence of such a history.