TY - JOUR
T1 - Left atrial spontaneous echo contrast in patients with rheumatic mitral valve disease in sinus rhythm
T2 - Implication of an altered left atrial appendage function in its formation
AU - Li, Y. H.
AU - Hwang, J. J.
AU - Ko, Y. L.
AU - Lin, J. L.
AU - Tseng, Y. Z.
AU - Kuan, P.
AU - Lien, W. P.
N1 - Funding Information:
This study was supported by the following grants: NSC 82-0115-B002-481 from National Science Council, Executive Yuan, ROC, and NTUH-84212-B34 from the National Taiwan University Hospital.
PY - 1995
Y1 - 1995
N2 - Thirty-nine patients who had rheumatic mitral valve disease in sinus rhythm were studied to compare echocardiographic and hemodynamic characteristics between those with and without left atrial (LA) spontaneous echo contrast. Patients were divided into two groups according to the presence (group 1, n=17) or absence (group 2, n=22) of the echo contrast. Transthoracic echocardiography and transesophageal echocardiography were performed in all patients within 1 week of cardiac catheterization study. Group I patients (5 men and 12 women; mean age, 47.7 ± 13.1 years) showed smaller mitral valve area, greater transmitral vane pressure gradient, and absence of moderate to severe mitral regurgitation compared with group 2 patients (7 men and 15 women; mean age, 47.8 ± 14.3 years). There was no significant difference in LA dimension, left ventricular end-systolic and end-diastolic dimensions, or in left ventricular ejection fraction between the two groups of patients. Left atrial appendage function was studied with Doppler in 26 patients. Patients (n=10) with LA spontaneous echo contrast had significantly lower LA appendage ejection fraction (20.34 ± 10.76% vs 34.16 ± 13.13%; p<0.05) and lower LA appendage peak emptying velocity (0.17 ± 0.09 m/s vs 0.27 ± 0.12 m/s; p<0.05) than those (n=16) without echo contrast. It is concluded that obstruction to mitral flow and altered LA appendage contractile function, not the LA size, are likely to be more important factors for the development of LA and LA appendage spontaneous echo contrast in patients with rheumatic mitral valve disease (predominant mitral stenosis) who are in sinus rhythm. These findings further substantiate that blood stasis in the LA cavity and the LA appendage is the mechanism fundamental to the formation of such spontaneous echo contrast.
AB - Thirty-nine patients who had rheumatic mitral valve disease in sinus rhythm were studied to compare echocardiographic and hemodynamic characteristics between those with and without left atrial (LA) spontaneous echo contrast. Patients were divided into two groups according to the presence (group 1, n=17) or absence (group 2, n=22) of the echo contrast. Transthoracic echocardiography and transesophageal echocardiography were performed in all patients within 1 week of cardiac catheterization study. Group I patients (5 men and 12 women; mean age, 47.7 ± 13.1 years) showed smaller mitral valve area, greater transmitral vane pressure gradient, and absence of moderate to severe mitral regurgitation compared with group 2 patients (7 men and 15 women; mean age, 47.8 ± 14.3 years). There was no significant difference in LA dimension, left ventricular end-systolic and end-diastolic dimensions, or in left ventricular ejection fraction between the two groups of patients. Left atrial appendage function was studied with Doppler in 26 patients. Patients (n=10) with LA spontaneous echo contrast had significantly lower LA appendage ejection fraction (20.34 ± 10.76% vs 34.16 ± 13.13%; p<0.05) and lower LA appendage peak emptying velocity (0.17 ± 0.09 m/s vs 0.27 ± 0.12 m/s; p<0.05) than those (n=16) without echo contrast. It is concluded that obstruction to mitral flow and altered LA appendage contractile function, not the LA size, are likely to be more important factors for the development of LA and LA appendage spontaneous echo contrast in patients with rheumatic mitral valve disease (predominant mitral stenosis) who are in sinus rhythm. These findings further substantiate that blood stasis in the LA cavity and the LA appendage is the mechanism fundamental to the formation of such spontaneous echo contrast.
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U2 - 10.1378/chest.108.1.99
DO - 10.1378/chest.108.1.99
M3 - Article
C2 - 7607001
AN - SCOPUS:0029049754
SN - 0012-3692
VL - 108
SP - 99
EP - 103
JO - Chest
JF - Chest
IS - 1
ER -