Mitral Regurgitation Protects from Left Atrial Thrombogenesis in Patients with Mitral Valve Disease and Atrial Fibrillation

• Published in: Pacing and clinical electrophysiology Vol. 23; no. 11P2; pp. 1863 - 1866
• Main Authors: KRANIDIS, ATHANASSIOS, KOULOURIS, SPYRIDON, FILIPPATOS, GERASIMOS, KAPPOS, KOSTAS, TSILIAS, KARMELOS, KARVOUNIS, HARIS, EXADAKTYLOS, NIKOLAOS
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.11.2000
• Subjects: atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - diagnostic imaging; Cardiac Volume; Echocardiography, Transesophageal; Female; Heart Atria - diagnostic imaging; Heart Atria - pathology; Heart Atria - physiopathology; Heart Valve Prosthesis; Humans; left atrial thrombus; Male; Middle Aged; mitral regurgitation; Mitral Valve Insufficiency - complications; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Stenosis - complications; Predictive Value of Tests; Rheumatic Heart Disease - complications; Rheumatic Heart Disease - diagnostic imaging; Risk Assessment; Thrombosis - complications; Thrombosis - diagnostic imaging
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/j.1540-8159.2000.tb07039.x

The aim of this study was to test the hypothesis that mitral regurgitation (MR) has a protective effect on the development of left atrial thrombus (LAT) in patients with rheumatic heart disease and atrial fibrillation (AF). The study population consisted of 48 anticoagulated patients (mean age = 57.1 ± 10 years). Predominant mitral stenosis (MS) was present in 14 patients, predominant MR in 14, and a mechanical valve in 20. All patients underwent detailed transesophageal echocardiography. Severity of MR was based on measurements of the MR jet by color flow mapping. Patients were divided into two groups: (a) those with MR ≥ 3 + (n =12, 25%), and (b) those without significant MR (n = 36, 75%). A LAT was found in six patients (12.5%), who also had spontaneous echo contrast (SEC), while another group of 30 patients (62.5%) had SEC only. LAT and/or SEC were present in 2/12 patients (16.6%) with significant MR versus 34/36 patients (94.4%) without significant MR (P < 0.001). In addition to the absence of significant MR, left atrial diameter (LAD) > 60 mm, and severity of MS were also related to the presence of thrombus and/or SEC. Significant MR had a protective effect against thromboembolism, although this effect was abolished if LAD > 60 mm was present. In conclusion, in patients with mitral valve disease and AF, significant MR protects against LAT formation and systemic embolization. This protective effect was lost when LAD was > 60 mm.