Prevalence of Cardio-embolic Event Among Patients with Spontaneous Echo Contrast on Transthoracic Echocardiography (SMOCC-Heart Study)

Results: The study results included 89 patients with SEC. The mean age was 53.9 ± 14.3, with 67% males. The underlying cardiac condition were ischemic heart disease in 68%, non-ischemic cardiomyopathy in 19.3%, and rheumatic valvular heart disease in 12.5%. The most common comorbities were hypertension (54%), renal insufficiency (34%), and diabetes mellitus (34%). Nineteen percent of the patients were in atrial fibrillation. The location of the SEC was in the left ventricle in 90%. The mean ejection fraction was 34.8 ± 16.3% and the ejection fraction was < 35% in 64%. Eighty eight percent had segmental to global hypokinesia. The prevalence of cardio-embolic events was 10%, of which 9.0% presented as stroke, while only 1.0% presented with acute limb ischemia. Conclusion and Recommendations: SEC is an imaging phenomenon that is associated with LV dysfunction with 64% of the patients with an EF of ≤ 35%. The presence of SEC increases the occurrence of cardioembolic events in this population with a prevalence of 10% compared to the reported incidence of 1.8 - 2.4% incidence among patients with LV systolic dysfunction. Albeit in higher percentages, the most common co-morbid conditions are also the same risk factors that are independently associated with increased cardiovascular events. That is why the association of SEC with cardio-embolic events as well as its management, is still not well established, and recommendations on anticoagulation still depend on established clinical scoring. Further study that would associate the different characteristics and co-morbid conditions of patients with SEC to cardio-embolic event is in order.