Predictive Factors of Systemic Embolism in Patients with Mitral Stenosis in Sinus Rhythm
Songsak Kiatchoosakun MD*, Chaiyasith Wongvipaporn MD*, Songkwan Silaruks MD*, Pyatat Tatsanavivat MD*
Affiliation : * Division of Cardiology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen
Background : Systemic embolism is one of the major complications in patients with mitral stenosis (MS) who
are in atrial fibrillation; however, this serious complication can also occur in patients with MS in sinus
rhythm.
Objective : The purpose of the present study was to identify the predictive factors of systemic emboli in patients
with MS in sinus rhythm.
Material and Method: Twenty patients with MS in sinus rhythm with recent cerebral embolism and 32 with MS
in sinus rhythm without any history of systemic embolism were studied between January 2004 and May 2006.
Clinical and echocardiographic data were assessed using stepwise logistic regression for prediction of
systemic embolism.
Results : Age (odds ratio [OR], 1.14; 95% confidence interval [CI] 1.04 -1.26) and left atrial spontaneous
echo contrast (LASEC) grade 3+ and 4+ (OR, 46.42; 95% CI, 5.00-436.49) were associated with, and
predictive of, systemic emboli, whereas left atrial appendage contraction flow velocities, left atrial size and
mitral valve area were not.
Conclusion : The present study demonstrates that age and LASEC are the major predictive factors of systemic
embolism in patients with MS in sinus rhythm. It would therefore be prudent to give anticoagulants to patients
in atrial fibrillation as well as to those in sinus rhythm at risk of systemic embolism.
Keywords : Systemic embolism, Mitral stenosis, Sinus rhythm
