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Transesophageal echocardiography risk factors for stroke in nonvalvular atrial fibrillation
1University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, Canada K1Y 4W7.
Insights
Transesophageal echocardiography (TEE) helps predict stroke risk in atrial fibrillation patients. Aortic plaque and left atrial appendage abnormalities are key indicators of thromboembolic events.
Area of Science:
- Cardiology
- Medical Imaging
- Clinical Research
Background:
- Atrial fibrillation (AF) is a prevalent arrhythmia, increasing thromboembolism risk, especially in elderly populations.
- Clinical risk factors are established for predicting thromboembolic events in AF patients.
- Transesophageal echocardiography (TEE) is increasingly evaluated for its role in AF patient assessment.
Purpose of the Study:
- To review the prognostic significance of transesophageal echocardiographic findings in predicting thromboembolic events, particularly stroke.
- To focus on prospective studies evaluating nonvalvular atrial fibrillation (NVAF) patients.
- To assess the incremental value of TEE findings beyond clinical risk factors.
Main Methods:
- Systematic review of recent prospective studies on TEE in nonvalvular atrial fibrillation.
- Analysis of echocardiographic findings such as aortic plaque, left atrial appendage (LAA) abnormalities, patent foramen ovale (PFO), and atrial septal aneurysm (ASA).
- Correlation of TEE findings with the incidence of thromboembolic events, especially stroke.
Main Results:
- Aortic plaque and left atrial appendage abnormalities are independent predictors of thromboembolic events in NVAF.
- These findings possess incremental prognostic value beyond established clinical risk factors.
- Other TEE findings like patent foramen ovale and atrial septal aneurysm were not identified as predictors in this patient group.
Conclusions:
- Transesophageal echocardiography is a valuable tool for risk stratification of thromboembolic events in nonvalvular atrial fibrillation.
- TEE findings, specifically aortic plaque and LAA abnormalities, aid in identifying high-risk patients.
- TEE will likely be crucial in future studies for evaluating novel treatment strategies in high-risk AF patients.
Abstract:
Atrial fibrillation is a common arrhythmia, particularly in the older age groups. It confers an increased risk of thromboembolism to these patients, and multiple clinical risk factors have been identified to be useful in predicting the risks of thromboembolic events. Recent studies have evaluated the role of transesophageal echocardiography (TEE) in the evaluation of patients with atrial fibrillation. The purpose of this review is to evaluate the significance of transesophageal echocardiographic findings in the prediction of thromboembolic events, particularly stroke, in patients with nonvalvular atrial fibrillation, with an emphasis on recently reported prospective studies. Aortic plaque and left atrial appendage abnormalities are identified as independent predictors of thromboembolic events. Although they are associated with clinical events, they also have independent incremental prognostic values. Other transesophageal echocardiographic findings, such as patent foramen ovale and atrial septal aneurysm, have not been found to be predictors of thromboembolic events in this patient group. Thus, TEE is a useful tool in stratifying patients with nonvalvular atrial fibrillation into different risk groups in terms of thromboembolic events, and it will likely play an important role in future studies to assess new treatment strategies in high-risk patients with atrial fibrillation.