Left Atrial Spontaneous Echo Contrast in Hypertrophic Cardiomyopathy with Atrial Fibrillation

Transesophageal echocardiography was performed to assess the incidence of left atrial spontaneous echo contrast in patients with hypertrophic cardiomyopathy, who were divided into two groups according to the presence (group 1-A; 10 patients) or absence (group 1-B; 5 patients) of persistent atrial fibrillation. Twelve patients with atrial fibrillation (group 2) served as control. Among these, 5 patients had mitral regurgitation and 8 patients lone atrial fibrillation. Left atrial spontaneous echo contrast was detected in 8 patients (80%) in group 1-A, none in group 1-B, and 3 patients (25%) in group 2. The incidence of echo contrast in group 1-A was significantly higher than that in the other 2 groups. The size of the left atrium was not statistically different among the 3 groups. Accordingly, hypertrophic cardiomyopathy with atrial fibrillation seemed to be a specific diseased state to favor the development of the left atrial spontaneous echo contrast. Previous reports suggested that the presence of left atrial spontaneous contrast was considered as a warning sign of left atrial thrombus and would be an indicator of increased risk of embolism. 1)2)3) Three of the 8 patients who had spontaneous echo contrast in group 1-A had a history of systemic embolization. We proposed that patients with hypertrophic cardiomyopathy with atrial fibrillation were in a high risk state of thromboembolism