Echocardiographic Predictors of Left Atrial Appendage Spontaneous Echocontrast in Patients with Stroke and Atrial Fibrillation

Abstract

The presence of spontaneous echocontrast (SEC) in the left atrium (LA) or LA appendage (LAA) has been associated with a higher risk of thromboembolism and cerebrovascular accidents. The purpose of this study was to define the new transesophageal echocardiographic predictors of SEC for patients with stroke and atrial fibrillation. We studied 47 patients with stroke and atrial fibrillation who were undergoing transesophageal echocardiography for the evaluation of source of cardiac emboli. Patients were divided into two groups based on the absence (group 1) or presence (group 2) of SEC in the LAA. Compared with group 1, group 2 had larger LA, larger LAA minimum and maximum areas, and decreased LAA flow velocity, LAA wall velocity, LAA tissue intensity, and intensity ratio. In the stepwise discriminate analysis tissue intensity of LAA, minimum LAA area, LAA flow velocity, and LAA wall velocity were found as independent predictors of LAA SEC. LAA wall velocity had the greatest area under the receiver operating characteristic curve, indicating that the most powerful parameter for SEC is LAA wall velocity. Decreased LAA flow velocity and LA wall velocity, increased LAA size, and less negative LAA tissue intensity are associated with SEC in patients with nonvalvular atrial fibrillation. Strain and strain measurements of LAA give no more benefit.