Prognostic value of trans-thoracic echocardiography in patients with acute stroke and atrial fibrillation: findings from the RAF study

Paciaroni, M. et al. (2016) Prognostic value of trans-thoracic echocardiography in patients with acute stroke and atrial fibrillation: findings from the RAF study. Journal of Neurology, 263(2), pp. 231-237. (doi: 10.1007/s00415-015-7957-3) (PMID:26566907)

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Abstract

Anticoagulant therapy is recommended for the secondary prevention of stroke in patients with atrial fibrillation (AF). T he identification of patients at high risk for early recurrence, which are potential candidates to prompt anticoagulation, is crucial to justify the risk of bleeding associated with early anticoagulant treatment. The aim of this study was to evaluate in patients with acute ischemic stroke and AF the association between findings at trans-thoracic echocardiography (TTE) and 90 days recurrence. In consecutive patients with acute ischemic stroke and AF, TTE was performed within 7 days from hospital admission. Study outcomes were recurrent ischemic cerebrovascular events (stroke or TIA) and systemic embolism. 854 patients (mean age 76.3 ± 9.5 years) underwent a TTE evaluation; 63 patients (7.4 %) had at least a study outcome event. Left atrial thrombosis was present in 11 patients (1.3 %) among whom 1 had recurrent ischemic event. Left atrial enlargement was present in 548 patients (64.2 %) among whom 51 (9.3 %) had recurrent ischemic events. The recurrence rate in the 197 patients with severe left atrial enlargement was 11.7 %. On multivariate analysis, the presence of atrial enlargement (OR 2.13; 95 % CI 1.06–4.29, p = 0.033) and CHA2DS2-VASc score (OR 1.22; 95 % CI 1.04–1.45, p = 0.018, for each point increase) were correlated with ischemic recurrences. In patients with AF-associated acute stroke, left atrial enlargement is an independent marker of recurrent stroke and systemic embolism. The risk of recurrence is accounted for by severe atrial enlargement. TTE-detected left atrial thrombosis is relatively uncommon.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Abdul-Rahim, Dr Azmil and Lees, Professor Kennedy
Authors: Paciaroni, M., Agnelli, G., Falocci, N., Caso, V., Becattini, C., Marcheselli, S., Rueckert, C., Pezzini, A., Poli, L., Padovani, A., Csiba, L., Szabó, L., Sohn, S.-I., Tassinari, T., Abdul-Rahim, A. H., Michel, P., Cordier, M., Vanacker, P., Remillard, S., Alberti, A., Venti, M., Acciarresi, M., D’Amore, C., Mosconi, M. G., Scoditti, U., Denti, L., Orlandi, G., Chiti, A., Gialdini, G., Bovi, P., Carletti, M., Rigatelli, A., Putaala, J., Tatlisumak, T., Masotti, L., Lorenzini, G., Tassi, R., Guideri, F., Martini, G., Tsivgoulis, G., Vadikolias, K., Liantinioti, C., Corea, F., Del Sette, M., Ageno, W., De Lodovici, M. L., Bono, G., Baldi, A., D’Anna, S., Sacco, S., Carolei, A., Tiseo, C., Imberti, D., Zabzuni, D., Doronin, B., Volodina, V., Consoli, D., Galati, F., Pieroni, A., Toni, D., Monaco, S., Baronello, M. M., Barlinn, K., Pallesen, L.-P., Kepplinger, J., Bodechtel, U., Gerber, J., Deleu, D., Melikyan, G., Ibrahim, F., Akhtar, N., and Lees, K. R.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Journal of Neurology
Publisher:Springer
ISSN:0340-5354
ISSN (Online):1432-1459
Published Online:14 November 2015
Copyright Holders:Copyright © 2016 Springer
First Published:First published in Journal of Neurology 263(2):231-237
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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