ABSTRACT
Background: The thromboembolic risk of atrial flutter (AFL) is not well defined. On the other hand, in atrial fibrillation (AF), the echocardiographic demonstration of thrombus or spontaneous echo contrast in the left atria or its appendage, a lower flow velocity in the left atrial appendage, and its reduced mobility, are well known risk factors of thromboembolism. Aim: To study the incidence of these echocardiographic risk factors in patients with AFL. Material and methods: We prospectively studied 50 consecutive patients with AFL comparing them with two groups of patients with a well known increased risk of thromboembolism: 54 patients with AF and 24 patients with sinus rhythm and severe mitral stenosis (RSEMS). The group of patients with AFL was also compared with a control group of 27 patients with sinus rhythm and no increased risk of thromboembolism. In each group, we studied the presence of thrombi and spontaneous echo contrast in the left atria and left atrial appendage, emptying velocity (Vel A), filling flow (Vel B) and motility of the left atrial appendage and left atrial dimensions. Results: When compared with control patients, AFL subjects had a higher incidence of spontaneous echo contrast in the left atria and left atrial appendage (11 and 42 percent respectively, p<0.05); slower flow velocity in the left atrial appendage (Vel A 69.25 ñ 25 and 41 ñ 19 cm/s respectively, Vel B 55 ñ 16 and 46 ñ 20 cm/s respectively, p<0.05); lower atrial appendage wall motility (4 and 84 percent respectively, p<0.001) and a larger left atrium (40 ñ 10 and 45 ñ 0.6 mm respectively, p<0.05). Patients with AFL had a lower incidence of echocardiographic abnormalities than subjects with AF or RSEMS. Thrombi were found in 2 patients with AFL, 12 patients with AF, 4 patients with RSEMS and in no control patient. Conclusions: In AFL, there are echocardiographic markers of increased thromboembolic risk in comparison with a control group. Nevertheless, the incidence of these factors is lower than in patients with AF or with RSEMS
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Atrial Flutter/complications , Thromboembolism/etiology , Atrial Flutter , Thromboembolism , Prospective Studies , Risk Factors , Echocardiography, Transesophageal/methods , Mitral Valve StenosisSubject(s)
Humans , Diagnostic Imaging/classification , Endoscopy, Gastrointestinal , Magnetic Resonance Spectroscopy , Cardiac Catheterization/methods , Contrast Media , Densitometry , Digestive System , Gastrointestinal Diseases , Gastrointestinal Diseases/diagnosis , Radiography, Thoracic/methods , Radionuclide Imaging , Thyroid Function Tests/methods , Tomography, Emission-Computed, Single-PhotonSubject(s)
Humans , Heart Valve Diseases/physiopathology , Mitral Valve Stenosis/diagnosis , Mitral Valve Stenosis/physiopathology , Mitral Valve Stenosis/therapy , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/physiopathology , Mitral Valve Insufficiency/therapy , Mitral Valve Prolapse/diagnosisABSTRACT
Nadie discute el gran aporte de la Ecocardiografía y el Doppler cardiaco en el diagnóstico, seguimiento y tratamiento de los cardiópatas. Sin embargo, se ha puesto escaso énfasis en la posibilidad que tienen de inducir a errores que signifiquen diagnosticar enfermedad cardiaca en el individuo normal. En este editorial se sañalan las causas más frecuentes de Iatrogenia provocadas por el mal uso de estas técnicas