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.
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M. Paciaroni has received honoraria as a member of the speaker bureaus for Sanofi-Aventis, Boehringer Ingelheim, Bayer and Pfizer. G. Agnelli has received honoraria as a member of the speaker bureau for Boehringer Ingelheim and Bayer. C. Becattini has received honoraria as a member of the speaker bureau for Bristol Meyer Squibb and Bayer. P. Michel has received a research grant from the Swiss National Science Foundation and the Swiss Heart Foundation; he has also received speaker fees from Bayer, Boehringer Ingelheim, Covidien, St. Jude Medical as well as honoraria for his advisory relationships with Pierre-Fabre, Bayer, Bristol Meyer Squibb, Amgen, and Boehringer Ingelheim. J. Putaala has received honoraria for lectures on atrial fibrillation and anticoagulants for Orion Pharma, Bristol Meyer Squibb, Pfizer, Bayer, and Boehringer Ingelheim. T. Tatlisumak has received honoraria for his consultancy and advisory relationships with Lundbeck and Boehringer Ingelheim. G. Tsivgoulis has received research support from the European Regional Development Fund, Project St. Anne´s University Hospital, Brno, International Clinical Research Center (FNUSA-ICRC) (No. CZ.1.05/1.1.00/02.0123). D. Toni has received honoraria as a member of the speaker bureaus and advisory boards of Boehringer Ingelheim and Bayer. The remaining authors report no conflicts of interest. The Authors report that no funding has been received for this study.
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The study has been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
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Paciaroni, M., Agnelli, G., Falocci, N. et al. Prognostic value of trans-thoracic echocardiography in patients with acute stroke and atrial fibrillation: findings from the RAF study. J Neurol 263, 231–237 (2016). https://doi.org/10.1007/s00415-015-7957-3
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DOI: https://doi.org/10.1007/s00415-015-7957-3