Usefulness of Transesophageal Echocardiography for Predicting Covert Paroxysmal Atrial Fibrillation in Patients with Embolic Stroke of Undetermined Source.
Aged
Aged, 80 and over
Atrial Appendage
/ diagnostic imaging
Atrial Fibrillation
/ complications
Echocardiography, Transesophageal
Female
Hospitalization
Humans
Intracranial Embolism
/ diagnostic imaging
Male
Middle Aged
Predictive Value of Tests
Prognosis
Retrospective Studies
Risk Assessment
Risk Factors
Stroke
/ diagnostic imaging
Time Factors
Atrial fibrillation
Embolic stroke of undetermined source
Transesophageal echocardiography
Journal
Cerebrovascular diseases extra
ISSN: 1664-5456
Titre abrégé: Cerebrovasc Dis Extra
Pays: Switzerland
ID NLM: 101577885
Informations de publication
Date de publication:
2019
2019
Historique:
received:
10
05
2019
accepted:
13
08
2019
pubmed:
23
9
2019
medline:
26
5
2020
entrez:
23
9
2019
Statut:
ppublish
Résumé
Covert paroxysmal atrial fibrillation (CPAF) is a major cause of embolic stroke of undetermined source (ESUS). However, detecting PAF during hospitalization in these patients is difficult. This study aimed to determine whether findings of transesophageal echocardiography (TEE) during hospitalization are associated with later detection of PAF in patients with ESUS. We retrospectively studied 348 patients with ESUS who were admitted to our hospital within 1 week of onset. These patients met the criteria of ESUS, underwent TEE during hospitalization, and were followed up for at least 1 year. We found PAF in 35 (10.0%) patients. In patients with PAF, spontaneous echo contrast (SEC) and low left atrial appendage flow (LAAF) by TEE and enlargement of the left atrial dimension (LAD) by transthoracic echocardiography were identified more frequently compared with those who did not have PAF. In multivariate analysis, SEC and an LAD ≥42 mm were independently associated with later detection of PAF (p < 0.05). An association of LAAF <46.9 cm/s and PAF was marginal (p = 0.09). The specificity of the combined finding of SEC and/or LAAF with that of LAD increased up to 90%, while that of LAD alone was 70%. The findings of TEE during hospitalization may be useful for identifying patients at increased risk of CPAF in patients with ESUS.
Sections du résumé
BACKGROUND
BACKGROUND
Covert paroxysmal atrial fibrillation (CPAF) is a major cause of embolic stroke of undetermined source (ESUS). However, detecting PAF during hospitalization in these patients is difficult.
OBJECTIVES
OBJECTIVE
This study aimed to determine whether findings of transesophageal echocardiography (TEE) during hospitalization are associated with later detection of PAF in patients with ESUS.
METHOD
METHODS
We retrospectively studied 348 patients with ESUS who were admitted to our hospital within 1 week of onset. These patients met the criteria of ESUS, underwent TEE during hospitalization, and were followed up for at least 1 year.
RESULTS
RESULTS
We found PAF in 35 (10.0%) patients. In patients with PAF, spontaneous echo contrast (SEC) and low left atrial appendage flow (LAAF) by TEE and enlargement of the left atrial dimension (LAD) by transthoracic echocardiography were identified more frequently compared with those who did not have PAF. In multivariate analysis, SEC and an LAD ≥42 mm were independently associated with later detection of PAF (p < 0.05). An association of LAAF <46.9 cm/s and PAF was marginal (p = 0.09). The specificity of the combined finding of SEC and/or LAAF with that of LAD increased up to 90%, while that of LAD alone was 70%.
CONCLUSIONS
CONCLUSIONS
The findings of TEE during hospitalization may be useful for identifying patients at increased risk of CPAF in patients with ESUS.
Identifiants
pubmed: 31542780
pii: 000502713
doi: 10.1159/000502713
pmc: PMC6787416
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
98-106Informations de copyright
© 2019 The Author(s) Published by S. Karger AG, Basel.
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