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Usefulness of Transesophageal Echocardiography for Predicting Covert Paroxysmal Atrial Fibrillation in Patients with

Yuichiro Ohya1, Masato Osaki2, Shigeru Fujimoto3

  • 1Department of Cerebrovascular Medicine, Stroke Center, Steel Memorial Yawata Hospital, Kitakyushu, Japan, ohya.r.yu.ichiro@gmail.com.

Cerebrovascular Diseases Extra
|September 23, 2019
PubMed

Insights

Transesophageal echocardiography (TEE) during hospitalization may help identify patients with embolic stroke of undetermined source (ESUS) who are at higher risk for covert paroxysmal atrial fibrillation (CPAF). Findings like spontaneous echo contrast and enlarged left atrial dimension are key indicators.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Imaging

Background:

  • Covert paroxysmal atrial fibrillation (CPAF) is a significant cause of embolic stroke of undetermined source (ESUS).
  • Detecting CPAF during hospitalization for ESUS is challenging.

Purpose of the Study:

  • To investigate the association between transesophageal echocardiography (TEE) findings during hospitalization and the subsequent detection of CPAF in ESUS patients.
  • To identify echocardiographic markers predictive of CPAF in ESUS.

Main Methods:

  • Retrospective study of 348 ESUS patients admitted within 1 week of onset.
  • All patients underwent TEE during hospitalization and were followed for at least 1 year.
  • Analysis included transthoracic echocardiography (TTE) for left atrial dimension (LAD).

Main Results:

  • CPAF was detected in 10.0% of patients.
  • Spontaneous echo contrast (SEC), low left atrial appendage flow (LAAF), and enlarged LAD were more frequent in patients with CPAF.
  • SEC and LAD ≥42 mm were independently associated with later CPAF detection (p < 0.05).
  • Combined SEC/LAAF and LAD showed 90% specificity for predicting CPAF.

Conclusions:

  • TEE findings during hospitalization can aid in identifying ESUS patients at increased risk for CPAF.
  • Echocardiographic markers like SEC and LAD may improve CPAF risk stratification in ESUS.
Abstract

Keywords:
Atrial fibrillationEmbolic stroke of undetermined sourceTransesophageal echocardiography

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