Transesophageal Echocardiography in Ischemic Stroke With Atrial Fibrillation
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 fibri...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-11-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.022242 |
| _version_ | 1811206302256332800 |
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| author | Kanta Tanaka Masatoshi Koga Keon‐Joo Lee Beom Joon Kim Tadataka Mizoguchi Eun Lyeong Park Juneyoung Lee Sohei Yoshimura Jae‐Kwan Cha Byung‐Chul Lee Junpei Koge Hee‐Joon Bae Kazunori Toyoda |
| author_facet | Kanta Tanaka Masatoshi Koga Keon‐Joo Lee Beom Joon Kim Tadataka Mizoguchi Eun Lyeong Park Juneyoung Lee Sohei Yoshimura Jae‐Kwan Cha Byung‐Chul Lee Junpei Koge Hee‐Joon Bae Kazunori Toyoda |
| author_sort | Kanta Tanaka |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-12T03:46:24Z |
| format | Article |
| id | doaj.art-663f422f38aa464e923c30bb630c650e |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-12T03:46:24Z |
| publishDate | 2021-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-663f422f38aa464e923c30bb630c650e2022-12-22T03:49:08ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-11-01102210.1161/JAHA.121.022242Transesophageal Echocardiography in Ischemic Stroke With Atrial FibrillationKanta Tanaka0Masatoshi Koga1Keon‐Joo Lee2Beom Joon Kim3Tadataka Mizoguchi4Eun Lyeong Park5Juneyoung Lee6Sohei Yoshimura7Jae‐Kwan Cha8Byung‐Chul Lee9Junpei Koge10Hee‐Joon Bae11Kazunori Toyoda12Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita JapanDepartment of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita JapanDepartment of Neurology Cerebrovascular Center Seoul National University Bundang Hospital Seongnam‐si South KoreaDepartment of Neurology Cerebrovascular Center Seoul National University Bundang Hospital Seongnam‐si South KoreaDepartment of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita JapanDepartment of Biostatistics College of Medicine Korea University Seoul South KoreaDepartment of Biostatistics College of Medicine Korea University Seoul South KoreaDepartment of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita JapanDepartment of Neurology Dong‐A University Hospital Busan KoreaDepartment of Neurology Hallym University Sacred Heart Hospital Anyang KoreaDepartment of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita JapanDepartment of Neurology Cerebrovascular Center Seoul National University Bundang Hospital Seongnam‐si South KoreaDepartment of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita JapanBackground 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.https://www.ahajournals.org/doi/10.1161/JAHA.121.022242atrial fibrillationechocardiographystroke |
| spellingShingle | Kanta Tanaka Masatoshi Koga Keon‐Joo Lee Beom Joon Kim Tadataka Mizoguchi Eun Lyeong Park Juneyoung Lee Sohei Yoshimura Jae‐Kwan Cha Byung‐Chul Lee Junpei Koge Hee‐Joon Bae Kazunori Toyoda Transesophageal Echocardiography in Ischemic Stroke With Atrial Fibrillation Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atrial fibrillation echocardiography stroke |
| title | Transesophageal Echocardiography in Ischemic Stroke With Atrial Fibrillation |
| title_full | Transesophageal Echocardiography in Ischemic Stroke With Atrial Fibrillation |
| title_fullStr | Transesophageal Echocardiography in Ischemic Stroke With Atrial Fibrillation |
| title_full_unstemmed | Transesophageal Echocardiography in Ischemic Stroke With Atrial Fibrillation |
| title_short | Transesophageal Echocardiography in Ischemic Stroke With Atrial Fibrillation |
| title_sort | transesophageal echocardiography in ischemic stroke with atrial fibrillation |
| topic | atrial fibrillation echocardiography stroke |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.022242 |
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