Left Ventricular Spontaneous Echo Contrast Complicating Dilated Cardiomyopathy: A Case Report of Cardioembolic Stroke in Brazzaville
Contraste Spontané Intraventriculaire Gauche Compliquant une Cardiomyopathie Dilatée : A Propos d'un Cas d'Accident Vasculaire Cérébral Cardio-Embolique à Brazzaville
DOI:
https://doi.org/10.67260/hra.v4i8.7933Keywords:
Spontaneous echo contrast; echocardiography; left ventricle; stroke; embolism; dilated cardiomyopathy; anticoagulation; BrazzavilleAbstract
RESUME Le contraste spontané intraventriculaire gauche est un état préthrombotique qui expose à des complications emboliques graves, notamment cérébrales. Nous rapportons le cas d'un homme de 59 ans, suivi depuis deux ans pour une insuffisance cardiaque chronique compensée compliquant une cardiomyopathie dilatée avec dysfonction systolique ventriculaire (fraction d'éjection à 37 %). Il a été admis aux urgences du CHU de Brazzaville pour une perte de connaissance brève suivie d'une hémiplégie gauche globale et d'une dysarthrie. L'imagerie par résonance magnétique cérébrale a objectivé une ischémie récente dans le territoire des artères cérébrales antérieures et moyennes droites. L'échocardiographie transthoracique a mis en évidence des cavités gauches dilatées, une hypokinésie globale et un contraste spontané intraventriculaire gauche. La biologie a révélé une CRP à 90 mg/l. Le traitement a associé la poursuite du traitement de l'insuffisance cardiaque (furosémide, ramipril, digoxine, nébivolol, dapagliflozine) à l'introduction d'un anticoagulant oral direct à partir du 15e jour, relayant l'héparinothérapie initiale, et à la rosuvastatine. L'évolution à J37 a montré la persistance de l'hémiplégie et du contraste spontané. Ce cas souligne l'importance de l'échocardiographie transthoracique dans le diagnostic du contraste spontané chez les patients porteurs d'une cardiomyopathie dilatée, et la nécessité d'une anticoagulation prolongée pour prévenir la récidive des accidents emboliques. ABSTRACT Left ventricular spontaneous echo contrast is a prethrombotic state that exposes patients to severe embolic complications, particularly cerebral. We report the case of a 59‑year‑old man who had been followed for two years for compensated chronic heart failure complicating dilated cardiomyopathy with left ventricular systolic dysfunction (ejection fraction 37%). He was admitted to the emergency department of Brazzaville University Hospital after a brief loss of consciousness followed by global left hemiplegia and dysarthria. Brain magnetic resonance imaging revealed recent ischaemia in the territory of the right anterior and middle cerebral arteries. Transthoracic echocardiography showed dilated left chambers, global hypokinesis and left ventricular spontaneous echo contrast. Laboratory tests revealed a C‑reactive protein level of 90 mg/L. Treatment combined continuation of heart failure therapy (furosemide, ramipril, digoxin, nebivolol, dapagliflozin) with introduction of a direct oral anticoagulant from day 15, following initial heparin therapy, and rosuvastatin. At day 37, the patient still had flaccid hemiplegia and persistent spontaneous echo contrast. This case highlights the value of transthoracic echocardiography in diagnosing spontaneous contrast in patients with dilated cardiomyopathy, and the need for prolonged anticoagulation to prevent recurrent embolic events.References
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Copyright (c) 2026 Kimbally-Kaky EG, Mongo Ngamami SF, Boubayi Motoula Latou D, Gankama TN, Makani Bassakouahou JK, Taty RJ, Kouala Landa CM, Ngolo Letomo K, Bakekolo RP, Ossou Nguie PM, Baragou S, Ellenga Mbolla BF
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