[Incidence and dynamic behavior of spontaneous echocardiographic contrast and atrial thrombi in the transplanted heart].
BACKGROUND
Standard orthotopic heart transplantation produces important anatomic and functional atrial alterations with subsequent thrombotic risk. Therefore the aim of this study was to analyze the prevalence and evolution of spontaneous echocardiography, atrial thrombi and embolic events.


METHODS
52 consecutive transplanted patients were analyzed with transesophageal echocardiography and hemodynamic studies performed at 15 days and one year after transplantation.


RESULTS
Spontaneous echocardiography contrast was present in 27 patients (52%). Ten atrial thrombi were observed (19.2%), 9 with spontaneous echocardiography contrast. Six atrial thrombi appeared on day 15 and 4 after one year (with spontaneous echocardiography contrast on the previous study). Using multiple logistic regression analysis left atrial size was the only independent predictor factor for spontaneous echocardiography contrast (OR = 1.27; 95% CI, 1.09-1.54) and was an important predictor factor of atrial thrombi formation (OR = 1.19; 95% CI, 1.04-1.42). Likewise, the main predictor of atrial thrombi was the presence of spontaneous echocardiography contrast (OR = 116; 95% CI, 8.4-999). The hemodynamic pattern did not predict either the presence of spontaneous echocardiography contrast or atrial thrombi. The global incidence of embolic events was 4% less than previously described.


CONCLUSIONS
The incidence of atrial thrombi and spontaneous echocardiographic contrast after standard orthotopic heart transplantation was 19.2% and 52%, respectively. An enlarged atrium and/or spontaneous echocardiography contrast was found to increase the risk of atrial thrombi. Considering the dynamic nature of atrial thrombi formation, periodical transesophageal echocardiography studies are recommended after heart transplantation.
Escribano Subias
P
P
Servicios de Cardiología Hospital 12 de Octubre, Madrid, Spain. med022585@nacom.es
Gómez-Sánchez
M A
MA
Fernández Casares
S
S
Lombera Romero
F
F
Delgado Jiménez
J F
JF
García Pascual
J
J
Pérez De La Sota
E
E
Rufilanchas
J J
JJ
Sáenz De La Calzada
C
C
D000704:Analysis of Variance; D001145:Arrhythmias, Cardiac / Q000209:etiology; D004452:Echocardiography; D004617:Embolism / Q000175:diagnosis; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D016027:Heart Transplantation / Q000000981:diagnostic imaging* / Q000379:methods / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000000981:diagnostic imaging*
Incidencia y comportamiento dinámico del contraste ecocardiográfico espontáneo y del trombo auricular en el corazón trasplantado.