Vol. 43 | No. 2 | July-December 2015 Back

Open Access

Spontaneous Echo Contrast is Associated with Increased Risk for Cardioembolic Events: A Meta-analysis

John Daniel A. Ramos, Jaime Alfonso M. Aherrera, Lowe L. Chiong, Edgar Wilson G. Timbol, Felix Eduardo R. Punzalan Jr
Dec 2015 DOI 10.69944/pjc.5b1183a12e

Abstract

Background: Spontaneous echo contrast (SEC) is a swirling smoke-like image seen inside the heart chambers or in the aorta on two-dimensional echocardiogram. It is theorized to be due to reduced blood flow, or stasis, and is considered a pre-thrombotic lesion. However, its association with cardioembolic (CE) events is not yet established. We aim to determine the association of SEC with CE events such as stroke and peripheral embolism. 

Methods: This meta-analysis includes observational studies with populations composed of adults ≥19 years old with documented SEC either in the cardiac chambers or the aorta; with reported data on CE events, especially stroke; and controlled for confounding variables by doing logistic regression and/or multivariate analysis. The authors conducted a systematic search of studies within the MEDLINE, EMBASE, ScienceDirect, and Cochrane Central Register of Controlled Trials databases in all languages; examined reference lists of studies; identified 14 studies that met the inclusion criteria; and obtained full manuscripts of all of them. Each study was assessed for quality using the Newcastle-Ottawa Quality Assessment Scale. The outcome of interest was assessed using Mantel-Haenzel analysis of random effects to compute for risk ratios, carried out using Review Manager (RevMan) 5.0.18. 

Results: Pooled analysis from the 14 studies enrolling a total of 4,659 patients showed that the presence of SEC was associated with increased CE events (27.9% vs. 26.4%; RR 3.50 95% CI 2.07–5.93 p < 0.00001 I2 = 89%). No evidence of publication bias was found by the funnel-plot method. To control for heterogeneity, we did subgroup and sensitivity analyses, which revealed that intracardiac SEC, particularly left atrial or left ventricular SEC, was primarily responsible for this association (22.8% vs. 5.8%; RR 4.69 95% CI 3.42–6.43 p < 0.00001 I2 = 0%), compared to extracardiac SEC, represented by aortic SEC (26.8% vs. 16.7%; RR 1.70 95% CI 1.05–2.77 p = 0.03 I2 = 53%). 

Conclusion: The presence of SEC is associated with a significantly increased risk for CE events among adult patients. This supports the need to be aggressive in the management of patients with SEC, particularly in reducing CE event risk. Clinical trials are warranted. 

Keywords: spontaneous echo contrast, rheologic stasis, cardioembolic events, embolic stroke

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