Investigation of Left Atrial Spontaneous Echo Contrast as a Marker Indicating Ineffective Anticoagulation in Patients with Mitral Valve Replacement Receiving Warfarin Spontaneous Echo Contrast Indicates Stroke
Ertugrul Emre Gunturk1, Melih Demirbas2, Yasemin Dogan2, Selcuk Dogan3, Inayet Gunturk41Department of Cardiology, Faculty of Medicine, Nigde Omer Halisdemir University, Nigde, Turkey, 2Department of Cardiology, Kayseri City Hospital, Kayseri, Turkey, 3Department of Cardiology, Tokat State Hospital, Tokat, Turkey, 4Nigde Omer Halisdemir University, School of Health, Nigde, Turkey;
Objectives: This study aimed to evaluate predictive role of left atrial (LA) spontaneous echo contrast (SEC) for ineffective anticoagulation by assessing time in therapeutic range (TTR) via international normalized ratio (INR) monitoring in patients with mitral valve replacement (MVR) and to determine its relationship with increased thromboembolic events. Methods: The study included patients with mechanical MVR. TTR was estimated using serial INR measurements. On transthoracic echocardiography, left ventricular end-systolic/end-diastolic diameters, LA diameter, ejection fraction were measured, and the presence of SEC was determined. Results: The study included 65 patients with MVR (30 with LA SEC) and 35 without LA SEC. There was a trend for higher rates of cerebrovascular event in the patients with SEC than in those without (30% vs. 14.3%, p=0.046). The LA diameter was higher and the TTR was lower in the patients with SEC than in those without. There was a significant negative correlation between TTR and thromboembolic events. Multivariable logistic regression analysis revealed the TTR and LA diameter as independent factors affecting SEC. Conclusion: In patients with MVR, low TTR and enlarged left atrium were independent predictors for future thromboembolic events. Monitoring INR is important to achieve higher TTR in the presence of LA SEC. Keywords: International normalized ratio, mitral valve replacement, spontaneous echo contrast, time in therapeutic range, warfarin
Cite This Article
Gunturk E, Demirbas M, Dogan Y, Dogan S, Gunturk I. Investigation of Left Atrial Spontaneous Echo Contrast as a Marker Indicating Ineffective Anticoagulation in Patients with Mitral Valve Replacement Receiving Warfarin Spontaneous Echo Contrast Indicates Stroke. EJMI. 2019; 3(2): 163-168
Corresponding Author: Ertugrul Emre Gunturk