Department of Cardiology, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan.
Echocardiography. 2024 Jan;41(1):e15752. doi: 10.1111/echo.15752.
Little is known about spontaneous echo contrast (SEC) in the descending aorta (DASEC), occurring with or without SEC in the left atrium (LASEC), in the presence of atrial fibrillation (AF). We examined the clinical significance of DASEC, including its relationship with LASEC, in patients with nonvalvular AF.
Among 176 patients, 41 (23%) had DASEC and 51 (29%) had LASEC. The patients were divided into four groups based on the presence/absence of LASEC and DASEC, as Group A: no SEC (n = 107); Group B: only LASEC (n = 28); Group C: only DASEC (n = 18); and Group D: both types of SEC (n = 23). Clinical and echocardiographic parameters were compared between groups, and the possible determinants of DASEC were evaluated.
Age, sex, and CHA DS -VASc score were similar in the four groups. Group D was more likely to have an increased LA diameter, decreased left ventricular ejection fraction (LVEF), and low LA appendage velocity compared to Group A. Group C had a smaller LA diameter and a higher appendage velocity than Group B. Multivariate logistic regression analysis, with age ≥75 years, female sex, LASEC, LVEF < 50%, and presence of DA plaques included as covariates, showed that LASEC (OR 4.22, 95% CI 1.92-9.26, p < .001) and LVEF < 50% (OR 2.70, 95% CI 1.12-6.52, p = .027) were significant determinants of DASEC. The prevalence of DASEC increased with increasing LASEC severity in order of none (13%), mild (28%), and dense (50%) (p < .001).
In nonvalvular AF patients, DASEC is common, and it partly originates from LASEC, particularly in the presence of LV systolic dysfunction.
在非瓣膜性心房颤动（AF）患者中，左心房自发性回声对比（LASEC）伴或不伴降主动脉自发性回声对比（DASEC）的发生率尚不清楚。我们检查了 DASEC 的临床意义，包括其与 LASEC 的关系，在非瓣膜性 AF 患者中。
在 176 例患者中，41 例（23%）有 DASEC，51 例（29%）有 LASEC。根据是否存在 LASEC 和 DASEC，将患者分为四组，A 组：无 SEC（n=107）；B 组：仅 LASEC（n=28）；C 组：仅 DASEC（n=18）；D 组：两种类型的 SEC（n=23）。比较各组之间的临床和超声心动图参数，并评估 DASEC 的可能决定因素。
四组间年龄、性别和 CHA DS -VASc 评分相似。与 A 组相比，D 组 LA 直径增大、左心室射血分数（LVEF）降低和 LA 心耳速度降低的可能性更大。与 B 组相比，C 组 LA 直径较小，心耳速度较高。多变量逻辑回归分析，以年龄≥75 岁、女性、LASEC、LVEF<50%和 DA 斑块存在为协变量，表明 LASEC（OR 4.22，95%CI 1.92-9.26，p<.001）和 LVEF<50%（OR 2.70，95%CI 1.12-6.52，p=.027）是 DASEC 的显著决定因素。随着 LASEC 严重程度的增加，DASEC 的患病率呈递增趋势，依次为无（13%）、轻度（28%）和重度（50%）（p<.001）。
在非瓣膜性 AF 患者中，DASEC 很常见，它部分来源于 LASEC，特别是在存在左心室收缩功能障碍时。
