The relationship between spontaneous echocontrast, transesophageal echocardiographic parameters, and blood hemoglobin levels

The impact of spontaneous echo contrast on tunneled dialysis catheter patency

BACKGROUND

Spontaneous echo contrast (SEC) is an ultrasonographic image of swirling blood flow resembling a dynamic, cigarette smoke-like image. It is mostly observed during the insertion of tunneled dialysis catheters (TDC) into internal jugular veins with ultrasound guidance, often different levels of SEC can be seen. The aim of this study is to investigate the impact of SEC detected during TDC insertion on the patency of the catheter.

METHODS

Patients who had a TDC insertion in our clinic between January 2015 and December 2020 were prospectively evaluated. The patients were grouped into five groups according to the sec level and followed.

RESULTS

A total of 226 patients were examined, among which 107 were male (47.3%). The mean age of all patients was 63.1 ± 9.5 years. SEC grade and catheter occlusion was evaluated, it was observed that higher SEC grades were correlated with faster catheter thrombosis postinsertion. During the follow-up period, it was found that, compared to the SEC 0 group, catheter thrombosis occurred 3.22 times faster in the SEC 1 group, 2.66 times faster in the SEC 2 group, 5.80 times faster in the SEC 3 group, and 26.33 times faster in the SEC 4 group. (HR: 3.22, 2.66, 5.80, 26.33, respectively). Hematological parameters were evaluated by regression analysis, it was observed that hemoglobin, fibrinogen, and platelet count were not risk factors for SEC formation and SEC grade.

CONCLUSION

Significant relationship was found between SEC grade detected during catheter insertion and catheter thrombosis in patients undergoing hemodialysis with a TDC.

The prevalence, predictors, and outcomes of spontaneous echocardiographic contrast or left ventricular thrombus in patients with HFrEF

Aims

This study aimed to determine prevalence, predictors, and association with ischaemic stroke risk of spontaneous echocardiographic contrast (SEC) or left ventricular thrombus (LVT) in patients with heart failure with reduced ejection fraction (HFrEF).

Methods and results

Clinical, echocardiographic, and follow‐up data from January 2009 through February 2019 were retrospectively extracted from electronic medical records of patients with heart failure with left ventricular ejection fraction < 40% by echocardiography on admission, with follow‐up to February 2020. Of 9485 consecutive patients with HFrEF, 123 (1.3%) presented LVT and 331 (3.5%) presented SEC. Patients with vs. those without SEC/LVT had larger left ventricular end‐diastolic volume (199.5 ± 77.7 vs. 165.8 ± 61.3 mL, P < 0.001), lower left ventricular ejection fractions (29.5 ± 7.0% vs. 33.7 ± 5.5%, P < 0.001), and more often ischaemic cardiomyopathy, apical aneurysm, chronic kidney diseases, and smoking habit. In Cox regression analysis, SEC and LVT were independent predictors for ischaemic stroke occurrence [hazard ratio (HR) = 2.40, 95% confidence interval (CI): 1.74–3.31; HR = 4.52, 95% CI: 2.77–7.40, both P < 0.001]. In patients with those without SEC or LVT, stroke risk was higher among those not on anticoagulants (HR = 2.55, 95% CI: 1.85–3.53; HR = 4.71, 95% CI: 2.84–7.81, both P < 0.001), but similar among those on anticoagulants (P > 0.05). In patients with sinus rhythm, the associations between SEC/LVT and ischaemic stroke persist with HRs of 2.57 (95% CI: 1.69–3.92) and 5.74 (95% CI: 3.38–9.75).

Conclusions

In patients with HFrEF, SEC was not uncommon and increased risk of ischaemic stroke as well as LVT. Anticoagulants could play a role in the reduction of stroke risk, suggesting that patients with SEC/LVT, even those in sinus rhythm, would benefit from systemic anticoagulation treatment.

Retrospective evaluation of the incidence and prognostic significance of spontaneous echocardiographic contrast in relation to cardiac disease and congestive heart failure in cats: 725 cases (2006-2011)

OBJECTIVE

To determine whether the presence of spontaneous echocardiographic contrast (SEC) in cats with cardiomyopathy is associated with increased mortality. To establish whether specific types of cardiomyopathy are more often associated with SEC in an attempt to provide a risk-stratification scheme for cats with increased risk of thromboembolic events.

DESIGN

Retrospective study 2006-2011.

SETTING

Tertiary referral and teaching hospital.

ANIMALS

Seven hundred twenty-five client-owned cats undergoing echocardiographic evaluation.

MEASUREMENTS AND MAIN RESULTS

Patient characteristics, including age, breed, clinical signs, type of cardiovascular disease, presence of SEC, and survival time were recorded. Thyroxine, HCT, and blood pressure were recorded when available. Among cats diagnosed with cardiac abnormalities based on echocardiographic findings, those with SEC were at significantly increased risk of death as compared to those without SEC. Cats with dilated cardiomyopathy, unclassified cardiomyopathy, and hypertrophic cardiomyopathy were significantly more likely to have SEC compared to cats with other types of cardiac disease.

CONCLUSIONS

Cats with cardiomyopathy and SEC have an increased risk of death compared to cats without SEC, although other previously identified factors such as the presence of congestive heart failure and increased left atrium to aorta ratio remain important determinants of mortality. Cats with hypertrophic cardiomyopathy, unclassified cardiomyopathy, and dilated cardiomyopathy may benefit from anticoagulant therapy due to the increased risk of SEC in these subpopulations.

Prognostic significance of spontaneous echocardiographic contrast detected by transthoracic and transesophageal echocardiography in the era of harmonic imaging

INTRODUCTION

Echocardiographic diagnosis of spontaneous intracardiac contrast is the reflection of interactions between erythrocytes and plasma proteins. Underlying conditions are associated with low blood flow velocities in the heart. We sought to determine whether spontaneous echo contrast (SEC) detected in the era of widespread use of harmonic imaging still reflects poor prognosis and risk of thromboembolism.

MATERIAL AND METHODS

We retrospectively analyzed the database of a tertiary cardiology centre echocardiographic laboratory and identified 60 patients with SEC, but without solid intracardiac structures, and subsequently selected 60 sex- and age-matched controls without SEC. Data regarding baseline characteristics, treatment and clinical course during follow-up (median: 33.5 months; 95% CI: 24.79-40) were gained based on hospital and out-patient clinic documentation and telephone interviews. The clinical end-points included: all-cause death, cardiovascular death, stroke or transient ischemic attack (TIA), pulmonary embolism, peripheral embolism and composite thromboembolic end-point.

RESULTS

We observed that in the whole study group (p = 0.0016) and in the subgroup evaluated by TTE (p = 0.005) SEC predicted higher mortality. In the group assessed by TEE, SEC correlated with higher probability of stroke or TIA (p = 0.04). By multivariate analysis, in all patients SEC was a predictor of cardiovascular death (OR = 7.63; p = 0.008) and its localization in the left atrium independently predisposed to thromboembolism (OR = 10.15; p = 0.012). Furthermore, left ventricular SEC detected by TTE also emerged as an independent determinant of higher mortality (OR = 5.26; p = 0.015).

CONCLUSIONS

Despite a lower threshold of detection using harmonic imaging SEC is still a risk factor of poor prognosis, especially when observed on transthoracic examination.

The effects of eosinophil on the left atrial thrombus in patients with atrial fibrillation

BACKGROUND

Atrial fibrillation (AF) is the most common cardiac rhythm disorder. Atrial fibrillation causes a 5-fold increased risk for thromboembolic stroke. It is known that eosinophils play an important role in thrombosis. We aimed to compare the number of eosinophil counts of the patients with and without thrombi in the left atrium (LA) or in the left atrial appendage (LAA) and to ascertain the association of eosinophil counts with the presence of thrombi.

METHOD

The study included 89 patients diagnosed with persistent AF who underwent transesophageal echocardiography and designated to undergo cardioversion. The patients were divided into 2 groups: group 1 consisted of 40 patients (18 male; average age 63.27 ± 1.4) who had thrombus formation in the LA or LAA, and group 2 consisted of 49 patients (23 male; average age 66.53 ± 1.56) who did not have any thrombus in the LA or LAA. These patients underwent concurrent routine biochemical tests and eosinophil count on whole blood count was also performed.

RESULTS

Baseline characteristics of the study groups were comparable. Group 1 patients had higher eosinophil and mean platelet volume values than group 2 (233.0 ± 30.7 vs 118.9 ± 11.8 and 9.77 ± 0.20 vs 8.27 ± 0.12 fL, P < .001, respectively). In group 1, the patients' LA diameter is higher than that in group II.

CONCLUSION

As a result, our study revealed a relationship between eosinophil count and LA thrombus in patients with nonvalvular AF.

Cardioembolic stroke in atrial fibrillation-rationale for preventive closure of the left atrial appendage

Atrial fibrillation is the most common cardiac arrhythmias, and a major cause of morbidity and mortality due to cardioembolic stroke. The left atrial appendage is the major site of thrombus formation in non-valvular atrial fibrillation. Loss of atrial systole in atrial fibrillation and increased relative risk of associated stroke point strongly toward a role for stasis of blood in left atrial thrombosis, although thrombus formation is multifactorial, and much more than blood flow irregularities are implicated. Oral anticoagulation with vitamin-K-antagonists is currently the most effective prophylaxis for stroke in atrial fibrillation. Unfortunately, this treatment is often contraindicated, particularly in the elderly, in whom risk of stroke is high. Moreover, given the risk of major bleeding, there is reason to be skeptical of the net benefit when warfarin is used in those patients. This work reviews the pathophysiology of cardioembolic stroke and critically spotlights the current status of preventive anticoagulation therapy. Various techniques to exclude the left atrial appendage from circulation were discussed as a considerable alternative for stroke prophylaxis.