Title:The Dilemma in the Management of Patients with Heart Failure with Reduced Ejection Fraction, Sinus Rhythm and Left Ventricular Spontaneous Echo Contrast: A Narrative Review
Volume: 22
Issue: 1
Author(s): Hedieh Alimi and Ali Tajik*
Affiliation:
- Faculty of Medicine, Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
Keywords:
Left ventricular, heart failure, spontaneous echo contrast, thromboembolism, anticoagulation, sinus rhythm.
Abstract: Heart failure (HF) is a complex clinical syndrome that arises from structural or functional
impairment of ventricular filling or ejection of blood, resulting in previous characteristic
symptoms of fatigue, dyspnea, and fluid retention. Among the complications of heart failure is
the development of spontaneous echo contrast (SEC), characterized by a smoke-resembling appearance
on echocardiograms, which indicates blood stasis in heart chambers. Despite being
identified as an echocardiographic marker in the left atrium that correlates with thrombus formation
and causes thromboembolic events, the clinical importance of left ventricular spontaneous
echo contrast (LV-SEC) and the appropriate management for patients with this condition
remain uncertain due to insufficient data. Anticoagulant therapy is generally recommended for
patients with established left ventricular thrombus (LVT). However, for patients with heart failure
with reduced ejection fraction (HFrEF) and sinus rhythm (SR), as a result of a decrease in
thromboembolic events over time, it is typically not recommended. The main challenge lies in
assessing the thromboembolic risk and determining appropriate management in patients with
HFrEF, sinus rhythm (SR), and left ventricular spontaneous echo contrast (LV-SEC), compared
to those with left ventricular thrombus (LVT) and those with HFrEF and SR without LV-SEC.
The aim of this paper is to review the guidelines and trials on clinical characteristics, outcomes,
and management of patients with LV-SEC and compare the suggested management with the established
management for LVT and HF patients with sinus rhythm without LV-SEC.
