Hwang J J, Ko F N, Li Y H, Ma H M, Wu G J, Chang H, Wang S M, Schie J T, Tseng Y Z, Kuan P
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, ROC.
Cardiology. 1994;85(2):69-75. doi: 10.1159/000176648.
The mechanisms leading to formation of spontaneous echo contrast (SEC), a smoke-like echo on echocardiography, are still controversial. To further explore the clinical implications and factors related to SEC formation, the correlation among echocardiographic variables, hematologic parameters or platelet aggregability, and the occurrence of SEC was studied in 119 patients with chronic nonvalvular atrial fibrillation. There were 75 men and 44 women with a mean age of 65 +/- 10 years (range 38-88). Left atrial SEC was detected in 39 patients (33%) by transesophageal echocardiography. Patients with history of systemic embolism were more frequently found to have left atrial SEC and left atrial thrombus by univariate analysis. Multivariate analysis showed that left atrial SEC (p < 0.001) was the only independent predictor of history of systemic embolism. Age, sex, left atrial or left ventricular dimension, left ventricular ejection fraction, antiplatelet or anticoagulant therapy and the percentage of lone atrial fibrillation were not significantly different between patients with and without left atrial SEC. Among the hematologic parameters, higher hematocrit was found in patients with left atrial SEC, while white blood cell and platelet counts were comparable in both groups. Platelet aggregability with different concentrations of inducers, adenosine diphosphate and collagen, was evaluated by the turbidimetric method in 15 patients with left atrial SEC and in 42 patients without left atrial SEC who were not receiving antiplatelet or anticoagulant therapy. No significant difference was found in platelet aggregability using four inducer concentrations between two groups of patients.(ABSTRACT TRUNCATED AT 250 WORDS)
导致自发回声增强（SEC）（超声心动图上类似烟雾的回声）形成的机制仍存在争议。为了进一步探讨与SEC形成相关的临床意义和因素，我们对119例慢性非瓣膜性心房颤动患者进行了研究，分析了超声心动图变量、血液学参数或血小板聚集性与SEC发生之间的相关性。患者中男性75例，女性44例，平均年龄65±10岁（范围38 - 88岁）。经食管超声心动图检查发现39例患者（33%）存在左心房SEC。单因素分析显示，有系统性栓塞病史的患者更常出现左心房SEC和左心房血栓。多因素分析表明，左心房SEC（p < 0.001）是系统性栓塞病史的唯一独立预测因素。有无左心房SEC的患者在年龄、性别、左心房或左心室大小、左心室射血分数、抗血小板或抗凝治疗以及孤立性心房颤动的比例方面无显著差异。在血液学参数中，左心房SEC患者的血细胞比容较高，而两组的白细胞和血小板计数相当。采用比浊法对15例左心房SEC患者和42例未接受抗血小板或抗凝治疗且无左心房SEC的患者进行了不同浓度诱导剂（二磷酸腺苷和胶原）诱导的血小板聚集性评估。两组患者在使用四种诱导剂浓度时的血小板聚集性无显著差异。（摘要截断于250字）
