Relationship Between Left Atrial Spontaneous Echo Contrast and the MAPH Score in Patients With Severe Rheumatic Mitral Stenosis

Objective Left atrial spontaneous echo contrast (SEC) is an echocardiographic finding in which blood—normally non-contrasting—appears as a swirling, smoke-like echogenic pattern. The presence of SEC in the left atrium is associated with an increased risk of thromboembolism, and this risk increases with higher SEC grades. The MAPH score has recently been defined as a simple index of whole-blood viscosity. In this study, we aimed to evaluate the relationship between the MAPH score and the presence and grade of SEC in patients with severe rheumatic mitral stenosis in sinus rhythm. Methods This single-center, retrospective study included 96 patients in sinus rhythm who underwent percutaneous mitral balloon valvuloplasty for severe mitral stenosis. SEC presence was assessed by transesophageal echocardiography in all patients. Patients were grouped according to SEC presence (SEC+/SEC−) and SEC grade. The MAPH score (age, MPV, hematocrit, total protein) was calculated for each patient. Results Among 96 patients, 75 (78.1%) were SEC(+) and 21 (21.9%) were SEC(−). The MAPH score was higher in the SEC(+) group (Mann–Whitney U = 389.5; p < 0.001). No significant association was found between SEC severity and the MAPH score (Kruskal–Wallis p = 0.487). In ROC curve analysis, MAPH showed a significant ability to discriminate between SEC presence and absence (AUC = 0.753; 95% CI 0.639–0.866; p < 0.001). According to the Youden index, the optimal cut-off was MAPH ≥ 3, with a sensitivity of 56.0% and a specificity of 90.5%. In multivariable analysis, the MAPH score, left atrial diameter, and mitral valve area were identified as independent predictors of SEC presence. The AUC of the model built using continuous component values was 0.766 (95% CI 0.655–0.877; p < 0.001). Conclusion The MAPH score showed significant predictive performance for SEC presence but limited ability to discriminate SEC grade.