Kalçık Macit, Güner Ahmet, Bayam Emrah, Yesin Mahmut, Kalkan Semih, Gürsoy Mustafa Ozan, Gündüz Sabahattin, Karakoyun Süleyman, Cerşit Sinan, Özkan Mehmet
Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey.
Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Turk Kardiyol Dern Ars. 2020 Mar;48(2):127-136. doi: 10.5543/tkda.2019.17266.
Spontaneous echo contrast (SEC) is defined as dynamic, smoke-like echoes within the cardiac cavities with a characteristic swirling motion seen on echocardiography. Clinical studies have demonstrated that SEC is a risk factor for left atrial thrombus formation and an important indicator for potential systemic embolism. Platelet indices have been associated with the presence of SEC in patients with mitral stenosis. The aim of this study was to investigate the relationship between platelet indices and SEC in patients with prosthetic heart valves.
A total of 89 patients [female: 38 (42.4%); median age: 52 years (range: 36-67 years)] with SEC formation in the left atrium, and 257 control subjects [female: 123 (47.5%); median age: 56 years (range: 45-65 years)] without SEC formation were enrolled. All of the patients were evaluated by using transthoracic and transesophageal echocardiography. Laboratory tests including complete blood count and biochemical parameters were analyzed.
Patients with SEC formation had more frequent atrial fibrillation, higher left atrial diameter (LAD) and lower left ventriular ejection fraction values. Platelet indices including platelet count, platelet distribution width, mean platelet volume, and plateletcrit did not differ between the groups. Increased LAD was detected as the only independent predictor of SEC development.
Platelet indices were not found to be associated with the presence of SEC formation in the left atrium among patients with mitral prosthetic valves. Therefore, the use of platelet indices alongside known echocardiographic and clinical risk factors to predict SEC development in patients with a mitral prosthesis is debatable.
自发显影（SEC）被定义为心脏腔内动态的、烟雾样回声，在超声心动图上可见特征性的漩涡运动。临床研究表明，SEC是左心房血栓形成的危险因素，也是潜在系统性栓塞的重要指标。血小板指标与二尖瓣狭窄患者的SEC存在相关。本研究的目的是探讨人工心脏瓣膜患者血小板指标与SEC之间的关系。
共纳入89例左心房有SEC形成的患者[女性：38例（42.4%）；中位年龄：52岁（范围：36 - 67岁）]，以及257例无SEC形成的对照者[女性：123例（47.5%）；中位年龄：56岁（范围：45 - 65岁）]。所有患者均采用经胸和经食管超声心动图进行评估。分析包括全血细胞计数和生化参数在内的实验室检查结果。
有SEC形成的患者房颤更频繁，左心房直径（LAD）更大，左心室射血分数更低。两组之间血小板计数、血小板分布宽度、平均血小板体积和血小板压积等血小板指标无差异。LAD增大是检测到的SEC发生的唯一独立预测因素。
在二尖瓣人工瓣膜患者中，未发现血小板指标与左心房SEC形成的存在相关。因此，将血小板指标与已知的超声心动图和临床危险因素一起用于预测二尖瓣人工瓣膜患者的SEC发生是有争议的。
