J Cardiovasc Ultrasound.  2009 Mar;17(1):10-15. 10.4250/jcu.2009.17.1.10.

Correlation between Stroke and Spontaneous Echo Contrast by Tissue Harmonic Imaging in Patients with Dilated Cardiomyopathy

• Kim MK
• Park DG

• KMID: 1473761
• DOI: http://doi.org/10.4250/jcu.2009.17.1.10

Abstract

BACKGROUND
Spontaneous echo contrast (SEC) has been considered as a predisposition to thromboembolism and cerebrovascular accident. However, there have been few reports on the prevalence and role of SEC in dilated cardiomyopathy (DCM). The aim of this study was to investigate the prognostic usefulness of SEC in predicting a stroke in patients with DCM.
METHODS
Between October 2001 and January 2008, transthoracic echocardiography with tissue harmonic imaging (THI) was performed for recognition of SEC in patients with DCM. Patients were divided into 2 groups according to the presence of SEC. Clinical characteristic data, echocardiographic parameters were compared between two groups.
RESULTS
In this retrospective study, 220 patients (136 men, age 62.8+/-15.4 years) with DCM (left ventricular ejection fraction 27.8+/-7.8%) were included. SEC in the left ventricle (LV) was observed in 24 patients (10.9%). Stroke occurred in 4 (16.7%) of patients with SEC and in 9 (4.6%) of patients without SEC. There were no differences in LA dimension (p=0.24) and LV end-diastolic dimension (p=0.88) between both groups. On univariate analysis, SEC and coronary heart disease at presentation had statistical significance of risk factors for stroke in these groups (p<0.05). On multivariate analysis, only SEC was an independent predictor for stroke (OR 4.393, 95% CI 1.116-17.290, p=0.03).
CONCLUSION
These results suggest that SEC by THI through transthoracic echocardiography has a strong association with stroke in patients with DCM. Therefore, this study may help in the risk stratification of cardiac embolism in patients with DCM.

Keyword

Spontaneous echo-contrast; Dilated cardiomyopathy; Stroke; Tissue harmonic imaging

MeSH Terms

Cardiomyopathy, Dilated
Coronary Disease
Echocardiography
Embolism
Heart Ventricles
Humans
Male
Multivariate Analysis
Prevalence
Retrospective Studies
Risk Factors
Stroke
Stroke Volume
Thromboembolism

Figure

• 

  Fig. 1 Apical 4-chamber view with tissue harmonic imaging through transthoracic echocardiography in patient with dilated cardiomyopathy shows diffuse spontaneous echo contrast in left ventricle (LV). LA: left atrium.

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