Prevalence and clinical implications of atrial spontaneous contrast in patients undergoing transesophageal echocardiography

Abstract

The prevalence of atrial spontaneous contrast was evaluated in 150 consecutive patients undergoing transesophageal echocardiography. Spontaneous contrast was observed in 29 patients (19%). It was seen in the left atrium in 24 patients, in the right atrium in 4 patients and in both atria in 1 patient. Spontaneous atrial contrast was not seen in the absence of an associated cardiac abnormality. Univariate analysis showed a significant relation between the presence of spontaneous contrast and significant mitral regurgitation (p < 0.05), the presence of mitral valve prostheses (p < 0.001), atrial fibrillation (p < 0.0001) and left atrial size (p < 0.001). Multivariate analysis showed that the presence of atrial fibrillation, prosthetic mitral valve and atrial size were independent factors for the presence of spontaneous contrast. However, of the 29 patients with spontaneous contrast, 13 (45%) were in sinus rhythm and in only 4 (16%) was the left atrial size >60 mm. Left atrial thrombus was detected in 9 of the 150 patients. Although spontaneous contrast was noted in 5 (55%) patients with left atrial thrombus and in only 20 (14%) patients without left atrial thrombus (p < 0.001), none of the 3 patients who had right atrial thrombus had spontaneous contrast in that chamber. Overall, 7 (58%) of the 12 patients with right or left atrial thrombi had no evidence of spontaneous contrast. Multivariate analysis showed that atrial fibrillation was the only independent clinical predictor of left atrial thrombus. Thus, spontaneous echocardiographic contrast is a common phenomenon observed in approximately 20% of the patients undergoing transesophageal echocardiography. Its relation with thrombus formation and prognostic significance requires further evaluation.