Relation of spontaneous echocontrast to prethrombotic state in patients with dilated cardiomyopathy

ABSTRACT

This study investigates the occurrence rate and the association of intracardiac spontaneous echocontrast [SEC] to the hemostatic state and also examines whether the presence of mitral regurgitation [MR] affects SEC and/or thrombus formation in patients with dilated cardiomyopathy [DCM]. Transthoracic and transesophageal echocardiographic studies were performed in 61 hospitalized patients with DCM. Platelet aggregability, prothrombin time [PT], prothrombin concentration, international normalized ratio [INR], activated partial thromboplastin time [PTT], protein C and protein S were estimated in all patients and in 20 healthy control subjects. SEC was observed in 64% [39/61] of patients. Intracardiac thrombi were detected in 8% [5/61], all of them had SEC. Systemic embolism occurred in 13% [5/39] of patients with SEC. SEC showed correlation with increased platelet aggregability and reduced protein C and protein S [P<0.01 for each]. MR jet area and the ratio between MR jet area and left atrial area [which signifies severity of MR] were significantly lower in patients with SEC [P<0.04 and P<0.02 respectively]. In conclusion, among patients with DCM, SEC is a common echocardiographic phenomenon and associated with a hypercoagulable state, thus assessment of hemostate may be useful for evaluating the risk of thromboembolism. Also the presence of significant MR may be protective against SEC and/or thrombus formation in patients with DCM