Reduction of left ventricular spontaneous echo contrast in cardiomyopathy by acute inotropic intervention or aggressive therapy

Clinical characteristics and outcomes in patients with echocardiographic left ventricular spontaneous echo contrast

BACKGROUND

Spontaneous echo contrast (SEC) is a known precursor to thrombus formation and thromboembolic events. This study aims to demonstrate the clinical characteristics and outcomes of patients with left ventricular spontaneous echo contrast (LV-SEC).

METHODS

Patients with consecutive echocardiogram performed from October 2009 to September 2019 were enrolled in this retrospective, single-center study. Those with LV-SEC were included, while patients complicated by left ventricular thrombus, with history of infective endocarditis, prosthetic valves, or lost to follow-up were excluded. The clinical endpoint was 1-year thromboembolic events (i.e. stroke and peripheral embolism).

RESULTS

Among 417 patients (mean age 63.5 ± 14.7 years; 86.8% men) with LV-SEC, the incidence of 1-year embolism was 12.9%. In multivariate Cox proportional hazard model, significant risk factors for thromboembolic event were age [hazard ratio (HR) = 1.022, 95% confidence interval (CI): 1.000-1.045], atrial fibrillation (AF) (HR = 2.292, 95% CI: 1.237-4.244), hemoglobin (HR = 1.032, 95% CI: 1.017-1.047), left ventricular ejection fraction (LVEF) (HR = 1.021, 95% CI: 1.002-1.041), and anticoagulant therapy (HR = 0.310, 95% CI: 0.168-0.572). For patients with repeated measurements for echocardiography, D-dimer (HR = 1.137, 95% CI: 1.051-1.231), and △LVEF (HR = 0.961, 95% CI: 0.928-0.996) were independently associated with the persistent LV-SEC.

CONCLUSION

The present study reported a high incidence of 1-year thromboembolic event in patients with LV-SEC. Age, AF, hemoglobin, LVEF were independent risk factors for 1-year embolism and a reduced risk of embolism was observed among patients with anticoagulation therapy. Additionally, D-dimer and △LVEF are independently associated with the persistent LV-SEC.

Predictors of Spontaneous Echo Contrast in Left Heart Chambers in Patients with Dilated Cardiomyopathy: Slowing Down Might not Always Mean Enjoying Life

Introduction:

Spontaneous echo contrast(SEC) is usually detected in heart chambers as a result of reduced flow velocity in the cavity. The clinical importance of SEC lies in its association with embolic events. The aim of our study was to determine the frequency of SEC in left heart chambers in sinus rhythm patients with dilated cardiomyopathy and predictors for its emergence.

Materials and Methods:

This was a prospective cross-sectional transesophageal echocardiography study conducted in 101 sinus rhythm patients with dilated heart and mild-to-moderate systolic dysfunction.

Results:

Moderate-degree SEC was found in the left ventricle(LV) in around 9% of patients, in the left atrium(LA) in 12% and in left atrial appendage(LAA) in 40%. Multiple regression analysis showed that lower heart rate(95% confidence interval[CI]: 0.845–0.978; P = 0.011) and larger LV end-systolic diameter(LVESD)(95% CI: 1.034–1.394; P = 0.017) were independent predictors for LV SEC presence. Lower LV ejection fraction(LVEF) (95% CI: [−0.079]–[−0.037]; P = 0.0001) was the only independent predictor for SEC in the LA. Whereas, independent predictors for SEC in LAA were lower heart rate(95% CI:[−0.030]–[−0.003]; P = 0.018), greater LA indexed diameter (95% CI: 0.016–0.116; P = 0.010), and higher value of C-reactive protein(CRP)(95% CI: 0.0026–0.031; P = 0.027).

Conclusions:

SEC in left heart chambers is a frequent finding in patients with dilated cardiomyopathy in sinus rhythm. Lower heart rate and LVEF, larger LVESD and LA, as well as higher CRP, predict the presence of SEC in left heart chambers. Lower heart rate might be an essential predictor for SEC presence and severity in these patients.

Acute myocardial infarction in a young bodybuilder taking anabolic androgenic steroids: A case report and critical review of the literature

We describe a case report of a 30-year-old bodybuilder suffering acute myocardial infarction (AMI). He had been taking stanozolol and testosterone for two months. The coronary angiogram showed high thrombotic burden in the left anterior descending artery without underlying atherosclerosis. Few case reports of AMI in athletes taking anabolic androgenic steroids (AASs) have been reported so far. AAS-related AMI is possibly underreported in the medical literature due to the desire of the affected individuals to hide AAS use. Physicians should always consider the possibility of AAS abuse in the context of a young athlete suffering AMI. AASs can predispose to AMI through the acceleration of coronary atherosclerosis. Additionally, thrombosis without underlying atherosclerosis or vasospasm is highly possible to cause AMI in AAS users. Complications after AMI may be more frequent in AAS users.

Effect of mitral regurgitation on left ventricular thrombus formation in dilated cardiomyopathy

To assess whether the presence of mitral regurgitation has a protective effect on left ventricular thrombus formation in a heterogeneous group of patients with dilated cardiomyopathy, a group of 103 patients with dilated cardiomyopathy identified by means of echocardiographic criteria was assembled over 1 year. The purpose of the study was to define a subgroup of patients with dilated cardiomyopathy from whom long-term anticoagulation might be withheld. Each echocardiogram was evaluated for the presence of left ventricular thrombus, presence and severity of mitral regurgitation, and ejection fraction. The role of clinical factors and clotting factors in left ventricular thrombus formation was assessed. Left ventricular thrombus was not present in 91 patients (group A) and was present in 12 patients (group B). Group B had larger left atrial and left ventricular systolic dimensions and decreased left ventricular systolic function. Mitral regurgitation jet area and ratio between mitral regurgitation jet area and left atrial area were lower (signifying less severe mitral regurgitation) among patients in group B. Although mitral regurgitation was equally present in group A and group B, severe mitral regurgitation was found only in group A patients ( 11 of 91 patients). Among patients with dilated cardiomyopathy, left ventricular ejection fraction is the factor most associated with left ventricular thrombus formation. The presence of severe mitral regurgitation may have a protective role in left ventricular thrombus formation.