Transesophageal Echocardiography in Ischemic Stroke With Atrial Fibrillation
- Authors
- Tanaka, Kanta; Koga, Masatoshi; Lee, Keon-Joo; Kim, Beom Joon; Mizoguchi, Tadataka; Park, Eun Lyeong; Lee, Juneyoung; Yoshimura, Sohei; Cha, Jae-Kwan; Lee, Byung-Chul; Koge, Junpei; Bae, Hee-Joon; Toyoda, Kazunori
- Issue Date
- 16-11월-2021
- Publisher
- WILEY
- Keywords
- atrial fibrillation; echocardiography; stroke
- Citation
- JOURNAL OF THE AMERICAN HEART ASSOCIATION, v.10, no.22
- Indexed
- SCIE
SCOPUS
- Journal Title
- JOURNAL OF THE AMERICAN HEART ASSOCIATION
- Volume
- 10
- Number
- 22
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/135717
- DOI
- 10.1161/JAHA.121.022242
- ISSN
- 2047-9980
- Abstract
- BACKGROUND: To clarify differences in clinical significance of intracardiac thrombi in nonvalvular atrial fibrillation-associated stroke as identified by transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE). METHODS AND RESULTS: Using patient data on nonvalvular atrial fibrillation-associated ischemic stroke between 2011 and 2014 from 15 South Korean stroke centers (n=4841) and 18 Japanese centers (n=1192), implementation rates of TEE/TTE, and detection rates of intracardiac thrombi at each center were correlated. The primary outcome was recurrent ischemic stroke at 1 year after the onset. A total of 5648 patients (median age, 75 years; 2650 women) were analyzed. Intracardiac thrombi were detected in 75 patients (1.3%) overall. Thrombi were detected in 7.8% of patients with TEE (either TEE alone or TEE+TTE: n=679) and in 0.6% of those with TTE alone (n=3572). Thrombus detection rates varied between 0% and 14.3% among centers. As TEE implementation rates at each center increased from 0% to 56.7%, thrombus detection rates increased linearly (detection rate [%]=0.11xTEE rate [%]+1.09 [linear regression], P<0.01). TTE implementation rates (32.3%-100%) were not associated with thrombus detection rates (P=0.53). Intracardiac thrombi were associated with risk of recurrent ischemic stroke overall (adjusted hazard ratio [aHR] 2.35, 95% CI, 1.07-5.16). Thrombus-associated ischemic stroke risk was high in patients with TEE (aHR, 3.13; 95% CI, 1.17-8.35), but not in those with TTE alone (aHR, 0.89; 95% CI, 0.12-6.51). CONCLUSIONS: Our data suggest clinical relevance of TEE for accurate detection and risk stratification of intracardiac thrombi in nonvalvular atrial fibrillation-associated stroke.
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