Retrospective Study of 1255 Non-Anticoagulated Patients with Nonvalvular Atrial Fibrillation to Determine the Risk of Ischemic Stroke Associated with Left Atrial Spontaneous Echo Contrast on Transesophageal Echocardiography

Objective. This meta-analysis aimed at exploring the predictive value of CHA2DS2-VASc score for the left atrial thrombus (LAT) or left atrial spontaneous echo contrast (LASEC) in patients with nonvalvular atrial fibrillation (NVAF). Methods. PubMed, Embase, Web of Science, ScienceDirect, Cochrane Library, and Chinese core journals of the CNKI and Wanfang databases were searched to identify all the relevant papers that were published up to January 2020. The data were extracted for pooled odds ratios (ORs) with 95% confidence intervals (CIs), heterogeneity, subgroup, publication bias, and sensitivity analysis. Results. Overall, 15 studies containing 6223 patients with NVAF were enrolled. All studies were evaluated for LAT, and 12 studies were evaluated for LASEC. The pooled analysis using a random-effects model showed that a high CHA2DS2-VASc score was related with LAT/LASEC (pooled OR=1.59, 95% CI: 1.35–1.88, P<0.001) with high heterogeneity (I2=76.9%, P<0.001) and LAT (pooled OR=1.83, 95% CI: 1.44–2.33, P<0.001) with high heterogeneity (I2=79.4%, P<0.001). The subgroup analysis demonstrated that the sample size may be the main source of heterogeneity. Although the Begg’s funnel plot based on 15 studies for LAT/LASEC (P=0.029) and 12 studies for LAT (P=0.046) indicated the presence of publication bias among the included studies, the trim-and-fill method verified the stability of the pooled outcomes. In addition, sensitivity analysis indicated that all effects were stable. Conclusion. The results of this meta-analysis showed that the CHA2DS2-VASc score is related with LAT and LASEC in patients with NVAF. However, more studies are warranted to address this issue.

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Left Atrial Size and Ischemic Events after Ischemic Stroke or Transient Ischemic Attack in Patients with Nonvalvular Atrial Fibrillation

Cerebrovascular Diseases ◽

10.1159/000511393 ◽

2020 ◽

Vol 49 (6) ◽

pp. 619-624

Author(s):

Keisuke Tokunaga ◽

Masatoshi Koga ◽

Sohei Yoshimura ◽

Yasushi Okada ◽

Hiroshi Yamagami ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Transient Ischemic Attack ◽

Left Atrial ◽

Nonvalvular Atrial Fibrillation ◽

Ischemic Event ◽

Increased Risk ◽

Ischemic Attack ◽

Ischemic Events

Background: The present study aimed to clarify the association between left atrial (LA) size and ischemic events after ischemic stroke or transient ischemic attack (TIA) in patients with nonvalvular atrial fibrillation (NVAF). Methods: Acute ischemic stroke or TIA patients with NVAF were enrolled. LA size was classified into normal LA size, mild LA enlargement (LAE), moderate LAE, and severe LAE. The ischemic event was defined as ischemic stroke, TIA, carotid endarterectomy, carotid artery stenting, acute coronary syndrome or percutaneous coronary intervention, systemic embolism, aortic aneurysm rupture or dissection, peripheral artery disease requiring hospitalization, or venous thromboembolism. Results: A total of 1,043 patients (mean age, 78 years; 450 women) including 1,002 ischemic stroke and 41 TIA were analyzed. Of these, 351 patients (34%) had normal LA size, 298 (29%) had mild LAE, 198 (19%) had moderate LAE, and the remaining 196 (19%) had severe LAE. The median follow-up duration was 2.0 years (interquartile range, 0.9–2.1). During follow-up, 117 patients (11%) developed at least one ischemic event. The incidence rate of total ischemic events increased with increasing LA size. Severe LAE was independently associated with increased risk of ischemic events compared with normal LA size (multivariable-adjusted hazard ratio, 1.75; 95% confidence interval, 1.02–3.00). Conclusion: Severe LAE was associated with increased risk of ischemic events after ischemic stroke or TIA in patients with NVAF.

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Integrated Backscatter Assessment of Left Atrial Spontaneous Echo Contrast in Chronic Nonvalvular Atrial Fibrillation: Relation with Clinical and Echocardiographic Parameters

Journal of the American Society of Echocardiography ◽

10.1067/mje.2000.104739 ◽

2000 ◽

Vol 13 (7) ◽

pp. 666-673 ◽

Cited By ~ 7

Author(s):

Takahide Ito ◽

Michihiro Suwa ◽

Ayaka Kobashi ◽

Hatsumi Yagi ◽

Tomomi Nakamura ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Nonvalvular Atrial Fibrillation ◽

Integrated Backscatter ◽

Spontaneous Echo Contrast ◽

Echocardiographic Parameters

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Transesophageal Echocardiography in Ischemic Stroke With Atrial Fibrillation

Journal of the American Heart Association ◽

10.1161/jaha.121.022242 ◽

2021 ◽

Author(s):

Kanta Tanaka ◽

Masatoshi Koga ◽

Keon‐Joo Lee ◽

Beom Joon Kim ◽

Tadataka Mizoguchi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Transesophageal Echocardiography ◽

Primary Outcome ◽

Nonvalvular Atrial Fibrillation ◽

Unique Identifier ◽

Detection Rates ◽

South Korean ◽

Ischemic Stroke Risk ◽

Intracardiac Thrombi

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 [%]=0.11×TEE 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. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01581502.

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