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Thromb Haemost
DOI: 10.1055/a-2688-6741
DOI: 10.1055/a-2688-6741
Review Article
Left Atrial Spontaneous Echo Contrast: Pathogenesis, Detection, and Modelling
Funding Information P.M. was funded by the Engineering and Physical Sciences Research Council (EPSRC) Research Council, part of the EPSRC CDT (grant reference: EP/R513064/1). S.W. acknowledges support from the British Heart Foundation (FS/20/26/34952). This work was supported by the Wellcome/EPSRC Centre for Medical Engineering (WT203148/Z/16/Z) at King's College London. The funders had no role in the preparation, review, or approval of the manuscript.
Abstract
The left atrium (LA) is particularly susceptible to blood stasis in conditions like atrial fibrillation (AF), which can lead to thrombus formation, especially in the left atrial appendage. Spontaneous echo contrast (SEC) in the LA, detectable via transesophageal echocardiography (TEE), occurs when blood flow slows, and has been strongly associated with thrombus formation and increased stroke risk, making it an important prognostic indicator. The underlying mechanism of LA SEC is thought to involve echogenic red blood cell aggregates formed due to low shear rates, but the roles of platelets and the coagulation cascade remain unclear. Given that LA SEC is considered a precursor to thrombus formation, enhancing our understanding of its pathophysiology may offer insights into thrombogenesis inside the LA, which to date remains poorly understood. The development of noninvasive diagnostic tools for LA SEC is critical, as TEE, whereas the gold standard is invasive and not universally accessible. Promising alternatives, such as harmonic transthoracic echocardiography and biphasic computed tomography imaging, have shown potential in diagnosing LA SEC and assessing stroke risk in AF patients. Additionally, emerging technologies like computational modelling are offering new avenues for understanding the mechanisms of LA SEC, with blood flow simulations providing valuable insights into its formation. These advancements could improve diagnostic capabilities and stroke risk stratification in AF patients, highlighting the need for further research to fully elucidate the clinical implications of LA SEC.
Keywords
spontaneous echo contrast - left atrium - red blood cell aggregation - transesophageal echocardiography - modellingThe review process for this paper was fully handled by Christian Weber, Editor in Chief.
Publication History
Received: 16 May 2025
Accepted: 21 August 2025
Accepted Manuscript online:
02 September 2025
Article published online:
09 September 2025
© 2025. Thieme. All rights reserved.
Georg Thieme Verlag KG
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