FREQUENCY OF LEFT ATRIAL THROMBUS IN PATIENTS WITH MITRAL STENOSIS

Abstract

Background: Mitral stenosis is a progressive valvular disorder commonly associated with rheumatic heart disease, particularly in low- and middle-income regions. Left atrial (LA) thrombus is a serious complication of mitral stenosis, increasing the risk of thromboembolic events such as stroke. While echocardiography remains the cornerstone of diagnosis, the prevalence and clinical associations of LA thrombus remain underexplored in regional populations, necessitating focused investigations to guide risk assessment and therapeutic strategies.

Objective: To determine the frequency of left atrial thrombus in patients diagnosed with mitral stenosis and assess its association with comorbid conditions.

Methods: A cross-sectional study was conducted at the Department of Cardiology, Mardan Medical Complex, from April to October 2024. One hundred patients aged 18–70 years with echocardiographically confirmed mitral stenosis (mitral valve area <1.5 cm²) were included using purposive sampling. Patients with mitral regurgitation, aortic valve disease, prior mitral interventions, or on anticoagulation therapy were excluded. LA thrombus was diagnosed through transthoracic echocardiography by detecting spontaneous echo contrast with dynamic, smoke-like patterns in the LA cavity and appendage. Data were analyzed using SPSS v21. Associations with comorbidities were assessed using chi-square and Fisher’s exact tests.

Results: Among 100 patients, 49 (49.0%) were male and 51 (51.0%) female, with a mean age of 43.7±13.4 years and mean BMI of 25.9±2.3 kg/m². LA thrombus was identified in 19 (19.0%) patients. Significant associations were observed with diabetes (63.2% vs. 14.8%, p<0.001), hypertension (78.9% vs. 7.4%, p<0.001), and smoking (73.7% vs. 11.1%, p<0.001). Thrombus was more frequent in patients with BMI 25–29.9 kg/m² (68.4%).

Conclusion: LA thrombus was prevalent in nearly one-fifth of mitral stenosis patients, particularly among those with metabolic and lifestyle-related comorbidities. Routine echocardiographic screening and integrated management of modifiable risk factors are essential to reduce thromboembolic complications.