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Spontaneous Echo Contrast — EECC MCQ

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EasyHeart FailureSpontaneous Echo ContrastEECC

A 70-year-old man with HFrEF (LVEF 25%) and AF undergoes echocardiography showing spontaneous echo contrast (SEC or 'smoke') in the left atrium. What is the significance of this finding?

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Correct answer: E — SEC indicates blood stasis and a prothrombotic state in the LA, associated with increased risk of LA thrombus formation and systemic thromboembolism; it reinforces the need for therapeutic anticoagulation

Spontaneous echo contrast (SEC, 'smoke') on echocardiography represents slow swirling blood flow patterns caused by red blood cell aggregation in areas of stasis. It is most commonly seen in the left atrium (particularly the LAA) in conditions associated with blood stasis: AF, severe LV dysfunction, mitral stenosis, and LA dilatation. SEC is a marker of a prothrombotic milieu and is associated with: (1) increased risk of LA/LAA thrombus; (2) higher stroke risk; (3) poor prognosis. The SEC grading system (1+ mild to 4+ severe dense SEC) correlates with thrombotic risk. SEC findings reinforce the indication for therapeutic anticoagulation and, when present during TOE before cardioversion, increase the suspicion for LAA thrombus even if no discrete thrombus is visualised.

Reference: ASE/EACVI Echo Guidelines; ESC (2024): AF Guidelines