FREQUENCY OF LEFT ATRIAL THROMBUS IN PATIENTS OF MITRAL STENOSIS WITH ATRIAL FIBRILLATION

Abstract

Background

Mitral stenosis is a common valvular heart disease and is often associated with atrial fibrillation. Combined, these conditions significantly heighten the risk of a thromboembolic event as a consequence of the formation of a left atrial thrombus that can lead to stroke and systemic embolization. Therefore, early detection of thrombus is crucial for proper management and prevention of complications.

Objective

To find out the prevalence of left atrial thrombus in patients with mitral stenosis and atrial fibrillation, and to see if there are any factors involved.

Place and duration of study. From May 2025 to October 2025, Cardiology Department Bolan Medical College / Hospital Quetta/ Sandeman Provincial Hospital, Quetta.

Methodology

This was a cross-sectional study carried out in the Department of Cardiology, a tertiary care hospital . Patients with echocardiographic ally confirmed mitral stenosis and atrial fibrillation were consecutively non-probability sampled over a period of one year and a total of 100 patients aged 18-70 years were finally enrolled. Patients with a history of cardiac surgery, congenital cardiac disease, long-term anticoagulation treatment, and high degree of comorbidities were excluded. A clinical evaluation and echocardiographic assessment (and transesophageal echocardiographic evaluation when appropriate) was carried out to identify left atrial thrombus. Data was analysed using SPSS version 26 and association was examined using Chi-square test with an acceptable level of significance p≤0.05.

Results

The mean age of participants was 47.8±11.2 years, with 58% females and 42% males. Left atrial thrombus was identified in 28 (28%) patients. Patients with thrombus were significantly older than those without thrombus (50.3±10.5 vs. 46.8±11.4 years; p=0.041). Thrombus occurrence was significantly associated with severe mitral stenosis (36.7% vs. 15.6%; p=0.018), atrial fibrillation duration greater than one year (40.9% vs. 17.9%; p=0.012), and left atrial enlargement (p=0.008). Gender showed no significant association with thrombus formation (p=0.214).

Conclusion

Patients with MS and atrial fibrillation are at high risk for the development of left atrial thrombus. Risk factors include advanced age, severe mitral stenosis, longer duration of atrial fibrillation, and left atrial enlargement. Early echocardiographic screening could help intervene in a timely manner and reduce the risk of a thromboembolic event.