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Article

PubMed

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Prognostic value of trans-thoracic echocardiography in patients with acute stroke and atrial fibrillation: findings from the RAF study

Journal of neurology. 2016 Feb ; 263 (2) : 231-237. [epub] 20151114

J Neurol
ISSN 1432-1459 | 0340-5354
Source

Language English Country Germany Media print-electronic

Document type Journal Article

Persistent link https://www.medvik.cz/link/pmid26566907

Grant support
MR/N003403/1 Medical Research Council - United Kingdom

PubMed 26566907
DOI 10.1007/s00415-015-7957-3
PII: 10.1007/s00415-015-7957-3
Knihovny.cz E-resources

Keywords
Acute stroke, Atrial fibrillation, Echocardiography, Outcome,
MeSH
Stroke diagnostic imaging etiology prevention & control MeSH
Echocardiography MeSH
Atrial Fibrillation complications diagnostic imaging MeSH
Humans MeSH
Prognosis MeSH
Recurrence MeSH
Risk Factors MeSH
Secondary Prevention methods MeSH
Aged MeSH
Check Tag
Humans MeSH
Male MeSH
Aged MeSH
Female MeSH
Publication type
Journal Article MeSH

Anticoagulant therapy is recommended for the secondary prevention of stroke in patients with atrial fibrillation (AF). T he identification of patients at high risk for early recurrence, which are potential candidates to prompt anticoagulation, is crucial to justify the risk of bleeding associated with early anticoagulant treatment. The aim of this study was to evaluate in patients with acute ischemic stroke and AF the association between findings at trans-thoracic echocardiography (TTE) and 90 days recurrence. In consecutive patients with acute ischemic stroke and AF, TTE was performed within 7 days from hospital admission. Study outcomes were recurrent ischemic cerebrovascular events (stroke or TIA) and systemic embolism. 854 patients (mean age 76.3 ± 9.5 years) underwent a TTE evaluation; 63 patients (7.4%) had at least a study outcome event. Left atrial thrombosis was present in 11 patients (1.3%) among whom 1 had recurrent ischemic event. Left atrial enlargement was present in 548 patients (64.2%) among whom 51 (9.3%) had recurrent ischemic events. The recurrence rate in the 197 patients with severe left atrial enlargement was 11.7%. On multivariate analysis, the presence of atrial enlargement (OR 2.13; 95% CI 1.06-4.29, p = 0.033) and CHA2DS2-VASc score (OR 1.22; 95% CI 1.04-1.45, p = 0.018, for each point increase) were correlated with ischemic recurrences. In patients with AF-associated acute stroke, left atrial enlargement is an independent marker of recurrent stroke and systemic embolism. The risk of recurrence is accounted for by severe atrial enlargement. TTE-detected left atrial thrombosis is relatively uncommon.

2nd Department of Neurology Attikon Hospital University of Athens School of Medicine Athens Greece

Abteilung für Neurologie Oberschwabenklinik gGmbH Ravensburg Germany

Centre Cérébrovasculaire Service de Neurologie Département des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois Lausanne Switzerland

Clinica Neurologica Azienda Ospedaliero Universitaria Pisa Italy

Department of Internal Medicine Cecina Hospital Cecina Livorno Italy

Department of Internal Medicine Insubria University Varèse Italy

Department of Internal Medicine Ospedale Civile di Piacenza Piacenza Italy

Department of Neurology and Psychiatry Sapienza University of Rome Rome Italy

Department of Neurology Born Bunge Institute Antwerp University Hospital Antwerp Belgium

Department of Neurology Democritus University of Thrace University Hospital of Alexandroupolis Alexandroupoli Greece

Department of Neurology Dresden University Stroke Center Dresden Germany

Department of Neurology Hamad Medical Corporation Doha Qatar