Clinical Usefulness of Transesophageal Echocardiography for Detection of LA Thrombi and Significance of Left Atrial Spontaneous Contrast

摘要

Background To evaluate the efficacy of transesophageal echocardiography(TEE) to detect left atrial thrombi(LAT) and to investigate the clinical and echocardiography parameters which related with LAT. Method We performed TEE and TTE simultaneously to 98 consecutive patients who had native mital valve disease or mital prosthesis as usual method. We examined the presence and location of LAT and spontaneous contrast(SC) in TEE and measured left atrial dimension(LAD), ejection fraction(EF), mital valve area(MVA) in TTE. Cardiac rhythm, history of anticoagulation and systemic embolization were also reviewed. We compared such parameters in LAT positiveegative groups and SC positiveegative groups. Results 1) In TEE, we detected 26 cases of LAT, among them seventeen cases : left atrial appendage(LAA) thrombi, 3 cases : combined LA and LAA thrombi, 6 cases : LA thrombi. In TTE, six cases showed LAT but we couldn't detect LAA thrombi. The difference between two methods was statistically significant(p 2) LAT positive group showed larger LAD, lower EF, and higher prevalence of AF, systemic embolization, and LAT than negative groups(p 3) SC positive group showed larger LAD, lower EF, higher prevalence of AF, systemic embolization LAT than SC negative groups(p 4) In multiple discriminant analysis, the history of systemic embolization was most important factor which can suspect LAT(Wilk's Lambda:0.77152. p Conclusion We can suggest that TEE is very useful method to detect LAT than TTE, and the spontaneous contrast was very important factor which can suggest LAT and systemic embolization in mitral valve disease.