Spontaneous Echo Contrast is Associated with Increased Risk for Cardioembolic Events: A Meta-analysis
Bibliographic record
Abstract
Background: Spontaneous echo contrast (SEC) is a swirling smoke-like image seen inside the heart chambers or in the aorta on two-dimensional echocardiogram. It is theorized to be due to reduced blood flow, or stasis, and is considered a pre-thrombotic lesion. However, its association with cardioembolic (CE) events is not yet established. We aim to determine the association of SEC with CE events such as stroke and peripheral embolism. Methods: This meta-analysis includes observational studies with populations composed of adults ≥19 years old with documented SEC either in the cardiac chambers or the aorta; with reported data on CE events, especially stroke; and controlled for confounding variables by doing logistic regression and/or multivariate analysis. The authors conducted a systematic search of studies within the MEDLINE, EMBASE, ScienceDirect, and Cochrane Central Register of Controlled Trials databases in all languages; examined reference lists of studies; identified 14 studies that met the inclusion criteria; and obtained full manuscripts of all of them. Each study was assessed for quality using the Newcastle-Ottawa Quality Assessment Scale. The outcome of interest was assessed using Mantel-Haenzel analysis of random effects to compute for risk ratios, carried out using Review Manager (RevMan) 5.0.18. Results: Pooled analysis from the 14 studies enrolling a total of 4,659 patients showed that the presence of SEC was associated with increased CE events (27.9% vs. 26.4%; RR 3.50 95% CI 2.07–5.93 p < 0.00001 I2 = 89%). No evidence of publication bias was found by the funnel-plot method. To control for heterogeneity, we did subgroup and sensitivity analyses, which revealed that intracardiac SEC, particularly left atrial or left ventricular SEC, was primarily responsible for this association (22.8% vs. 5.8%; RR 4.69 95% CI 3.42–6.43 p < 0.00001 I2 = 0%), compared to extracardiac SEC, represented by aortic SEC (26.8% vs. 16.7%; RR 1.70 95% CI 1.05–2.77 p = 0.03 I2 = 53%). Conclusion: The presence of SEC is associated with a significantly increased risk for CE events among adult patients. This supports the need to be aggressive in the management of patients with SEC, particularly in reducing CE event risk. Clinical trials are warranted. Keywords: spontaneous echo contrast, rheologic stasis, cardioembolic events, embolic stroke
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.018 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.014 | 0.035 |
| Bibliometrics | 0.004 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".