Echocardiographic determination of risk factors for left atrial thrombi in mitral stenosis: a multivariate analysis
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Left atrial thrombus with systemic emboli is a serious complication and economic burden in patients with mitral stenosis. At present long-term anticoagulation with warfarin is indicated in patients with rheumatic mitral valve disease only in the presence of atrial fibrillation or with previous systemic emboli, In an exploratory study we found the severity of the mitral valve lesion alone not to be a risk factor for Heft atrial thrombi in mitral stenosis, but when complicated by atrial fibrillation or Heftatrial enlargement, especially ≥ 4.8 cm, there appears to be a higher risk for the development of Heftatrial thrombi. The purpose of this study was to investigate the risk factors for Heftatrial thrombi in patients with mitral stenosis and to identify criteria for antlcoagulant therapy to prevent thromboembolism, One hundred and forty six patients with predominant mitral stenosis (mitral valve area less than 2.0 cm2) and on no anticoagulant therapy were examined by transthoracic and transesophageal echocardiography for the detection of Heftatrial thrombi. Age, sex, rhythm, left atrial size, mitral valve area, spontaneous echo contrast, mitral regurgitation and Beft ventricular ejection fraction were investigated as possible risk factors for left atrial thrombi. Both a univariate am multivariate analysis of the data were performed. Left atrial thrombi were detected in 26 (I7.8%) of the 146 patients. Through multivarlate analysis, atrial· fibrillation, left atrial size ≥ 4.8 cm, Heft ventricular ejection fraction <50%) and moderate or severe spontaneous echo contrast have been found to be independent risk factors for Heft atrial thrombi, and should be included as indications for anticoagulant therapy to prevent thromboembolism.