title: Predictive factors of left atrial spontaneous echo contrast in patients with rheumatic mitral valve stenosis: a retrospective study of 159 patients.
abstract: BACKGROUND
  Mitral valve stenosis is a common manifestation of chronic rheumatic heart disease. The presence of spontaneous echo contrast in the left atrium and left atrial appendage has been reported to be an independent predictor of thrombo-embolic risk in patients with mitral stenosis. The objective of this study was to retrospectively investigate various clinical and echocardiographic variables to predict the spontaneous echo contrast in these patients.
  
  
  METHODS
  This is a bicentric retrospective study which includes 159 cases of symptomatic mitral stenosis from January 2011 to June 2012. All of the patients had transthoracic and transesophageal echocardiography. Patients who had significant mitral regurgitation (> Grade I), significant aortic valve disease, previous mitral valvulotomy and anticoagulation or antiplatelet therapy were excluded from the study. Our study population was divided into two groups based on the presence (Group I) or absence (Group II) of spontaneous echo contrast.
  
  
  RESULTS
  Left atrial spontaneous contrast was present in 34.6% of cases. Patients in this group have more frequent atrial fibrillation (P = 0.001), larger left atrial area (P = 0.027) and diameter (P=0.023), smaller mitral valve area (P = 0.025), and higher mean transmitral diastolic gradient (p = 0.003) as compared to patients without spontaneous echo contrast. There were no significant differences in the mean age (p = 0.38), duration of symptoms (p = 0.4) and left ventricular ejection fraction (p = 0.7) between patients with and without spontaneous echo contrast. On multivariate analysis, only mitral valve area and transmitral diastolic gradient (OR: 18.753, 1.21, CI [1,838-191,332], [1,064-1,376], p: 0.013, 0.004, respectively) were found to be independently associated to the presence of spontaneous echo contrast.
  
  
  CONCLUSIONS
  Patients with severe rheumatic mitral stenosis in atrial fibrillation or sinus rhythm have a higher risk of developing spontaneous echo contrast. These patients might benefit from prophylactic anticoagulation. The long-term outcomes can be ascertained in a study over a longer period and with periodic follow-up.
authors.affiliation: Department of Cardiology, Mohammed V Military Teaching Hospital, Rabat, Morocco ; Department of Cardiology, Avicenne University Hospital, Rabat, Morocco.
authors.forename: Sanaa
authors.initials: S
authors.lastname: Drissi
authors.affiliation: Department of Cardiology, Mohammed V Military Teaching Hospital, Rabat, Morocco.
authors.forename: Hicham
authors.initials: H
authors.lastname: Sabor
authors.affiliation: Department of Cardiology, Mohammed V Military Teaching Hospital, Rabat, Morocco ; Department of Cardiology, Avicenne University Hospital, Rabat, Morocco.
authors.forename: Ahlam
authors.initials: A
authors.lastname: Ounsy
authors.affiliation: Department of Cardiology, Mohammed V Military Teaching Hospital, Rabat, Morocco.
authors.forename: Najat
authors.initials: N
authors.lastname: Mouine
authors.affiliation: Department of Cardiology, Mohammed V Military Teaching Hospital, Rabat, Morocco.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Sabry
authors.affiliation: Department of Cardiology, Mohammed V Military Teaching Hospital, Rabat, Morocco.
authors.forename: Aatif
authors.initials: A
authors.lastname: Benyass
authors.affiliation: Department of Cardiology, Mohammed V Military Teaching Hospital, Rabat, Morocco.
authors.forename: El Mehdi
authors.initials: el M
authors.lastname: Zbir
authors.affiliation: Department of Cardiology, Avicenne University Hospital, Rabat, Morocco.
authors.forename: Konate
authors.initials: K
authors.lastname: Lassana
authors.affiliation: Department of Cardiology, Avicenne University Hospital, Rabat, Morocco.
authors.forename: Naima
authors.initials: N
authors.lastname: Elhaithem
keywords: Anticoagulation; Left atrial spontaneous contrast; Mitral stenosis; Transesophageal echocardiography