Correlation between Stroke and Spontaneous Echo Contrast by Tissue Harmonic Imaging in Patients with Dilated Cardiomyopathy

Introduction Spontaneous echo contrast (SEC) is a smokelike echo phenomenon with a swirling pattern of blood flow that can be observed in transesophageal echocardiography (TEE) or transthoracic echocardiography (TTE), most often within the left atrium or left ventricle. SEC is first described by Feigenbaum in 1975, which has been observed under conditions of low blood flow velocity, such as rheumatic mitral stenosis, mitral valve prosthesis, atrial fibrillation (AF), dilated left atria and dyskinetic segments of the left ventricle (LV). SEC has been reported in 16% to 19% of patients selected to undergo TEE for standard indications. Dilated cardiomyopathy (DCM) probably is the end result of myocardial damage produced by various causes and shows various clinical manifestations. One of various clinical manifestations is SEC. However, there have been few reports on the prevalence of SEC in DCM. SEC is significantly associated with a history of embolism and left atrial (LA) or LV thrombi detected by echocardiography, severity of mitral stenosis, reduced cardiac index, advanced age, atrial fibrillation, hypertension, heart failure, and large left atrial diameter. SEC is a cardiac factor most