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[Echocardiographic and hematological variables as a risk factor for stroke in chronic nonvalvular atrial
Insights
Transesophageal echocardiography revealed key indicators for ischemic stroke risk in atrial fibrillation patients. Lower left atrial appendage flow velocity and increased spontaneous echo contrast predict stroke incidence.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Atrial fibrillation is a major risk factor for ischemic stroke.
- Identifying predictive markers for stroke in atrial fibrillation is crucial for patient management.
Purpose of the Study:
- To investigate the relationship between echocardiographic variables and ischemic stroke incidence in patients with chronic nonvalvular atrial fibrillation.
- To determine if specific echocardiographic findings can predict stroke risk.
Main Methods:
- Transthoracic and transesophageal echocardiography were performed on 67 patients with chronic nonvalvular atrial fibrillation.
- Plasma levels of D-dimer and thrombin-antithrombin III complex were measured.
- Patients were divided into a stroke group (n=13) and a nonstroke group (n=54).
Main Results:
- No significant differences were found in age, sex, left ventricular ejection fraction, or hematologic parameters between groups.
- The stroke group exhibited significantly lower left atrial appendage emptying flow velocity (21 +/- 5 cm/sec vs 32 +/- 3 cm/sec).
- Spontaneous echo contrast in the left atrium was significantly more prevalent in the stroke group (69% vs 26%).
Conclusions:
- Transesophageal echocardiographic variables, specifically reduced left atrial appendage flow velocity and increased spontaneous echo contrast, are correlated with ischemic stroke risk in nonvalvular atrial fibrillation.
- These echocardiographic findings may serve as valuable predictors for stroke in this patient population.
Abstract:
The relationship between echocardiographic variables and the incidence of ischemic stroke in patients with atrial fibrillation was investigated by transthoracic and transesophageal echocardiography in 67 patients with chronic nonvalvular atrial fibrillation. Hematologic variables were also measured simultaneously, including plasma levels of D-dimer and thrombin-antithrombin III complex in these patients. There was a prior history of ischemic stroke in 13 patients (stroke group), but not in the other 54 patients (nonstroke group). There were no significant differences in age, sex, left ventricular ejection fraction, left ventricular end-diastolic diameter, left atrial diameter or hematologic parameters between the groups. The left atrial appendage emptying flow velocity was lower in the stroke group than in the nonstroke group (21 +/- 5 vs 32 +/- 3 cm/sec, p < 0.05), and the incidence of left atrial spontaneous echo contrast was significantly higher in the stroke group than in the nonstroke group (69% vs 26%, p < 0.01). There was no significant difference in the incidence of left atrial thrombi between the groups (23% vs 12%). These findings suggest that transesophageal echocardiographic variables are correlated with the risk of ischemic stroke in patients with chronic nonvalvular atrial fibrillation.