O.S. Sychov, A.O. Borodai, E.S. Borodai. Thrombogenic milieu in patients with atrial flutter

The aim – to establish prevalence of thrombogenic milieu (TM) in heart cavities and associated clinical and echocardiographic findings in patients with typical atrial flutter (AFl) and evaluate silent cerebral infarctions in these patients.

Material and methods. Transesophageal and transthoracic echocardiographic examinations were performed in 100 consecutive patients with AFl in whom cardioversion or radiofrequency ablation procedures were planned. In each case, specific care was taken to identify atrial TM (either atrial thrombi and/or left atrial appendage sludge) or ventricular thrombi. Clinical and echocardiographic data were analyzed to determine frequency and relevant clinical associations of these thromboembolic risk markers. Brain multislice computed tomography was performed in 29 patients to evaluate prevalence of silent cerebral infarctions.

Results. Left atrial appendage (LAA) sludge was detected in 5 (5.2 %), LAA thrombus in 4 (4.2 %) and LV thrombus in 7 (7 %) cases. Reduced left ventricular ejection fraction (LV EF) < 40 % (Р≤0.005) and early diastolic tissue Doppler velocity on mitral valve lateral segment Em < 8 cm/s (Р<0.0001), were most significantly associated with left atrial TM, while LV EF < 40 % was most significantly associated with LV thrombus (Р<0.0001). Silent cerebral infarctions ≥ 15 mm were detected in 3 of 29 (10.3 %) cases and were associated with low LAA velocity (Р=0.03). Overt cardioembolic strokes not related to cardioversion were significantly associated with LV thrombi (Р=0.0005) and LAA sludge (Р=0.04). Conclusions. Although there were several significant echocardiographic associations with TM, none were strong enough to obviate the need for TEE in AFl patients. Silent cerebral infarctions ≥ 15 mm in patients with AFl had the same prevalence as in patients with atrial fibrillation. Thrombogenic milieu was significantly associated with overt strokes.

Full article