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Dilated Cardiomyopathy (DC) is a progressive disease of cardiac chambers, with prevalence of systolic dysfunction of left ventricle (LV) that becomes enlarged and cannot pump blood efficaciously. It is the third most common cause of heart failure and the most frequent cause of heart transplantation. The term is employed to indicate an idiopathic or familial DC (primitive DC). Other known causes are: chronic hypertension, valvular diseases, toxic exposure (cobalt), chronic alcoholism, autoimmune diseases, and the use of certain drugs or pregnancy (secondary DC) [1]. But, DC with low ejection fraction% (EF%) secondary to coronary artery disease, even though is the most frequent secondary DC [2], must be excluded from our debate. It is known that DC with low EF% of LV favors the aggregates of red blood cells and fibrinogen. Instead, the platelets do not participate to this reduction because aren’t echogenic [3-5]. The interaction between erythrocytes and plasma proteins causes a slowing down of hematic fluidity, responsible of increased echogenicity. That appears (at echocardiography) such as spiral of smoke, also named as spontaneous echo-contrast (SEC). Usually, SEC is often present in non-valvular atrial fibrillation (NVAF) and can cause a risk of thromboembolic cerebral events antagonized by novel oral anticoagulant drugs (NOACs) [6]. But, SEC can also be evident in LV-DC patient in sinus rhythm [7]. In the present review, we debated about the causes of cerebral embolism originating by SEC of non-ischemic LV of DC in sinus rhythm.

Spontaneous echo-contrast in LV non-ischemic dilated cardiomyopathy in sinus rhythm. What therapy to prevent cardio-embolic events?