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J Neurol. 2016 Feb;263(2):231-237. doi: 10.1007/s00415-015-7957-3. Epub 2015 Nov 14.

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

Author information

1
Stroke Unit and Division of Cardiovascular Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Via G. Dottori 1, 06100, Perugia, Italy. maurizio.paciaroni@unipg.it.
2
Stroke Unit and Division of Cardiovascular Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Via G. Dottori 1, 06100, Perugia, Italy.
3
Neurologia d'urgenza e Stroke Unit, Istituto Clinico Humanitas, Rozzano, Milan, Italy.
4
Abteilung für Neurologie, Oberschwabenklinik gGmbH, Ravensburg, Germany.
5
Neurology Unit, Department of Clinical and Experimental Sciences, University "Health and Wealth" of Brescia, Brescia, Italy.
6
Stroke Unit, University of Debrecen, Debrecen, Hungary.
7
Department of Neurology, Keimyung University School of Medicine, Taegu, South Korea.
8
Stroke Unit-Department of Neurology, Santa Corona Hospital, Pietra Ligure, Savona, Italy.
9
Medical School and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
10
Centre Cérébrovasculaire, Service de Neurologie, Département des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois, Lausanne, Switzerland.
11
Department of Neurology, Born Bunge Institute, Antwerp University Hospital, Antwerp, Belgium.
12
Stroke Unit, Neuroscience Department, University of Parma, Parma, Italy.
13
Stroke Unit, Dipartimento Geriatrico Riabilitativo, University of Parma, Parma, Italy.
14
Clinica Neurologica, Azienda Ospedaliero-Universitaria, Pisa, Italy.
15
SSO Stroke Unit, UO Neurologia, DAI di Neuroscienze, AOUI Verona, Verona, Italy.
16
Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.
17
Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden.
18
Department of Neurology, Sahlgrenska University Hospital, Göteborg, Sweden.
19
Department of Internal Medicine, Cecina Hospital, Cecina, Livorno, Italy.
20
Stroke Unit, AOU Senese, Siena, Italy.
21
Department of Neurology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupoli, Greece.
22
International Clinic Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.
23
Second Department of Neurology, "Attikon" Hospital, University of Athens, School of Medicine, Athens, Greece.
24
UO Gravi Cerebrolesioni, San Giovanni Battista Hospital, Foligno, Italy.
25
Stroke Unit, Department of Neurology, Sant'Andrea Hospital, La Spezia, Italy.
26
Department of Internal Medicine, Insubria University, Varèse, Italy.
27
Stroke Unit, Neurology, Insubria University, Varèse, Italy.
28
Stroke Unit, Ospedale di Portogruaro, Portogruaro, Venice, Italy.
29
Department of Neurology, University of L'Aquila, L'Aquila, Italy.
30
Department of Internal Medicine, Ospedale Civile di Piacenza, Piacenza, Italy.
31
Municipal Budgetary Healthcare Institution of Novosibirsk, City Clinical Hospital #1, Novosibirsk, Russia.
32
Stroke Unit, Jazzolino Hospital, Vibo Valentia, Italy.
33
Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.
34
Stroke Unit, Ospedale Civico, Palermo, Italy.
35
Department of Neurology, Dresden University Stroke Center, Dresden, Germany.
36
Department of Neurology, Hamad Medical Corporation, Doha, Qatar.

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.

KEYWORDS:

Acute stroke; Atrial fibrillation; Echocardiography; Outcome

PMID:
26566907
DOI:
10.1007/s00415-015-7957-3
[Indexed for MEDLINE]

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