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Right atrial spontaneous echo contrast indicates a high incidence of perfusion defects in pulmonary scintigraphy in patients with atrial fibrillation

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Abstract

This study investigated the relationship between right atrial SEC (RA-SEC) and silent pulmonary embolism (PE) in patients with nonvalvular atrial fibrillation (NVAF). Spontaneous echo contrast (SEC) within the cardiac chambers is associated with an increased risk of thromboembolism. However, most studies have examined the relationship between left atrial SEC and systemic thromboembolic disease. Transesophageal echocardiography (TEE) was performed in 210 patients with NVAF to assess a risk of thromboembolism. Right atrial SEC was detected in 37 patients, and 35 of these patients with RA-SEC and 29 patients without RA-SEC were enrolled in this study. However, patients with a history of symptomatic PE or deep vein thrombosis were excluded. Spontaneous echo contrast was diagnosed by TEE as the presence of smokelike echoes that swirled in a circular pattern. PE was diagnosed by pulmonary scintigraphy. Thrombotic and thrombolytic parameters, including serum concentrations of plasmin-α-plasmin inhibitor complex (PIC), thrombin-antithrombin complex (TAT), D-dimer, and fibrinogen were measured in all patients. Left ventricular dimension, cardiac function, and hematologic parameters were similar in the two groups. Nevertheless, the incidence of perfusion defects in pulmonary scintigraphy was significantly higher in the group with RA-SEC (40%) than in the group without RA-SEC (7%; chi-square, P = 0.006). The increased incidence of perfusion defects in pulmonary scintigraphy in patients with RA-SEC indicates that right atrial SEC may be a predictable factor at a high risk of PE.

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Authors and Affiliations

  1. Cardiovascular Division, Osaka Minami Medical Center, 2-1 Kidohigashi-machi, Kawachinagano, Osaka, 586-8521, Japan

    Yoshinori Yasuoka & Kunio Miyatake

  2. Cardiovascular Division, Osaka National Hospital, Osaka, Japan

    Johji Naito, Keiji Hirooka, Wakatomi Chin, Hideo Kusuoka & Yukihiro Koretsune

Authors
  1. Yoshinori Yasuoka
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  2. Johji Naito
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  3. Keiji Hirooka
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  4. Wakatomi Chin
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  5. Kunio Miyatake
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  6. Hideo Kusuoka
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  7. Yukihiro Koretsune
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Correspondence to Yoshinori Yasuoka.

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Yasuoka, Y., Naito, J., Hirooka, K. et al. Right atrial spontaneous echo contrast indicates a high incidence of perfusion defects in pulmonary scintigraphy in patients with atrial fibrillation. Heart Vessels 24, 32–36 (2009). https://doi.org/10.1007/s00380-008-1084-3

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  • DOI: https://doi.org/10.1007/s00380-008-1084-3

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