Department of Cardiology, The Key Laboratory of Cardiovascular Disease of Wenzhou, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, PR China.
MAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, PR China.
Int J Cardiol. 2021 May 1;330:245-250. doi: 10.1016/j.ijcard.2021.02.005. Epub 2021 Feb 10.
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).
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).
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.
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.
自发性回声对比（SEC）是血栓形成和血栓栓塞事件的已知前兆。本研究旨在展示左心室自发性回声对比（LV-SEC）患者的临床特征和结局。
这项回顾性单中心研究纳入了 2009 年 10 月至 2019 年 9 月连续进行超声心动图检查的患者。纳入了存在 LV-SEC 的患者，排除了伴有左心室血栓形成、感染性心内膜炎病史、人工瓣膜或失访的患者。临床终点为 1 年血栓栓塞事件（即中风和外周栓塞）。
在 417 例（平均年龄 63.5±14.7 岁；86.8%为男性）存在 LV-SEC 的患者中，1 年栓塞的发生率为 12.9%。多变量 Cox 比例风险模型显示，血栓栓塞事件的显著危险因素为年龄[风险比（HR）=1.022，95%置信区间（CI）：1.000-1.045]、心房颤动（AF）（HR=2.292，95%CI：1.237-4.244）、血红蛋白（HR=1.032，95%CI：1.017-1.047）、左心室射血分数（LVEF）（HR=1.021，95%CI：1.002-1.041）和抗凝治疗（HR=0.310，95%CI：0.168-0.572）。对于接受重复超声心动图测量的患者，D-二聚体（HR=1.137，95%CI：1.051-1.231）和 LVEF（HR=0.961，95%CI：0.928-0.996）与持续存在的 LV-SEC 独立相关。
本研究报告了 LV-SEC 患者 1 年血栓栓塞事件的发生率较高。年龄、AF、血红蛋白、LVEF 是 1 年栓塞的独立危险因素，抗凝治疗可降低栓塞风险。此外，D-二聚体和 LVEF 与持续存在的 LV-SEC 独立相关。
