SOME NON INVASIVE PREDICTORS OF LEFT ATRIAL APPENDAGE THROMBUS IN PATIENTS WITH RHEUMATIC MITRAL STENOSIS AND SINUS RHYTHM

Abstract

Mitral stenosis remains as a significant public health problem in developing countries, It have been demonstrated that marked LAA dysfunction in patients with mitral stenosis, which associated with a predisposition for the development of left atrial thrombus, independent of various haemostatic variables indicating platelets or coagulation activation, LAA thrombi have been considered to be the major source of systemic arterial embolization in patients .. with MS. Transesophageal echocardiography allows highly accurate imaging of the

LAA and LAA thrombus; however TEE is a semi-invasive procedure that is uncomfortable for some patients and contraindicated in others. Therefore, it is desirable to obtain at least' some information regarding LAA function and probability of LAA thrombus through non invasive methods.

The current study was carried out in the department of cardiology, EI­ Minya University during the period from November 2005 to August 2006.

The study included 32 patients with rheumatic mitral stenosis their mean mitral valve area (MVA) was 1.1±0.2 cm2

Patients were divided according to the presence of spontaneous echo contrast (SEC) by transesophageal echocardiography (TEE) into two groups:

Group 1: patients with SEC (n=18) (56. 3%) (Three of them had LAA thrombus)

Group 2: patients without SEC (n=14) (43.8%).

Group1 had statistically significant increased mean P wave maximum duration and increased mean P wave dispersion as compared with group2(127 ± 16 vs 107 ± 8, P < 0.001 63 ± 12 vs 37 ± 8, P < 0.001; respectively). P wave dispersion <!50msec had sensitivity of 89 % with specificity 93% and an accuracy of 90% for presence of SEC.