&quot;Correlation of right atrial volumes and spontaneous echo contrast with left atrial appendage thrombosis in atrial fibrillation patients undergoing elective cardioversion: A cross sectional study&quot;

Riad, Mohamed; Salah, Ahmed; Samy, Mina; Shokry, Khaled

doi:10.21608/arcmed.2025.414646.1158

	"Correlation of right atrial volumes and spontaneous echo contrast with left atrial appendage thrombosis in atrial fibrillation patients undergoing elective cardioversion: A cross sectional study"
ARCADEs of MEDICINE
Articles in Press, Accepted Manuscript, Available Online from 26 August 2025
Document Type: Original Research
DOI: 10.21608/arcmed.2025.414646.1158
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Authors
Mohamed Riad ¹; Ahmed Salah²; Mina Samy³; Khaled Shokry⁴
¹Armed forces college of medicine
²Department of Cardiology, Al-Azhar University
³Cardiology department, AFCM
⁴Cardiology department, Military Medical Academy
Abstract
Background: While the left atrium (LA) has been the primary focus of echocardiographic assessment in atrial fibrillation (AF), right atrial (RA) remodeling may also play a critical role in arrhythmogenesis and thromboembolic risk. Objective: To assess RA size and function using transthoracic echocardiography (TTE), and to explore their association with spontaneous echo contrast (SEC) and left atrial appendage (LAA) thrombus in AF patients undergoing transesophageal echocardiography (TEE). Methods: In this observational cross-sectional study, 54 patients with symptomatic AF underwent comprehensive TTE and TEE evaluation. RA size was indexed to body surface area (RAVI), and RA function was assessed via TAPSE, E/E′ ratio, and IVRT. LA SEC was graded, and LAA thrombus presence was recorded. Associations between RA parameters, SEC, and thrombus were analyzed using chi-square and Spearman correlation. Results: The median RAVI was 32.8 mL/m² (IQR = 19.3). RA SEC was present in 29.6% of patients, and LAA thrombus was identified in 27.8%. RA SEC was significantly associated with LAA thrombus (p = 0.02). A strong relationship was observed between higher LA SEC grades and RA SEC (p = 0.002). RAVI correlated positively with LAVI (r = 0.5, p = 0.001), and tricuspid E/E′ correlated with both LAA flow velocity (r = 0.281, p = 0.04) and LA SEC grade (p = 0.02). Conclusion: Right atrial SEC and structural remodeling are closely associated with LAA thrombus and severe LA SEC. These findings support the role of bi-atrial assessment in AF.
Keywords
Atrial fibrillation; Right atrium; spontaneous echo contrast


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