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[Esophageal echocardiography in patients with cerebrovascular stroke and atrial fibrillation]
1I. interní klinika FN Motol, Praha.
Insights
Atrial fibrillation increases stroke risk, necessitating anticoagulant therapy. Transesophageal echocardiography (TEE) identified clot sources in 24% of patients with atrial fibrillation and cerebrovascular attacks, confirming the need for anticoagulation.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Atrial fibrillation is a significant risk factor for cerebrovascular events.
- Anticoagulant therapy is crucial for patients with atrial fibrillation to prevent embolization.
- Transesophageal echocardiography (TEE) aids in identifying embolic sources, especially in patients with contraindications to anticoagulation.
Purpose of the Study:
- To investigate the utility of TEE in identifying the source of embolization in patients with atrial fibrillation and ischemic cerebrovascular attacks (CVA).
- To determine the prevalence of specific cardiac findings associated with embolism in this patient cohort.
Main Methods:
- Transesophageal echocardiography (TEE) was performed on 52 patients diagnosed with atrial fibrillation and ischemic CVA.
- Transthoracic echocardiography was insufficient in identifying the source of embolization in these patients.
Main Results:
- TEE revealed a thrombus in the left atrial appendage in 10% of patients.
- Spontaneous echocontrast, indicative of a prethrombotic state, was observed in 9% of patients.
- An open foramen ovale was identified in 5% of patients, suggesting a potential embolic source.
Conclusions:
- The findings strongly suggest a high probability of embolic etiology in patients experiencing CVAs secondary to atrial fibrillation.
- These results support the absolute indication for anticoagulant treatment in patients with cerebrovascular attacks and atrial fibrillation.
Abstract:
Atrial fibrillation is an important risk factor of embolization into the CNS. Thus affected patients should receive permanent anticoagulant therapy. Oesophageal echocardiography (TEE) can help our decision in patients with relative contraindications of anticoagulant therapy. TEE was performed in 52 patients with atrial fibrillation and cerebrovascular attack (CMP) with an ischaemic aetiology. Transthoracic echocardiography did not reveal the source of embolization. In 10% patients a thrombus was found in the appendage of the left atrium, in another 9% patients a spontaneous echocontrast was found in the left atrium (prethrombotic condition) and in 5% patients an open foramen ovale. The results indicate the highly probable etiology of embolization in patients with cerebrovascular attacks and atrial fibrillation. This supports the recommendation of absolute indication of anticoagulant treatment in patients with cerebrovascular attacks and atrial fibrillation.