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...

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Autores principales:	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
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	atrial fibrillation echocardiography stroke Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/663f422f38aa464e923c30bb630c650e
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spelling	oai:doaj.org-article:663f422f38aa464e923c30bb630c650e2021-11-16T10:22:43ZTransesophageal Echocardiography in Ischemic Stroke With Atrial Fibrillation10.1161/JAHA.121.0222422047-9980https://doaj.org/article/663f422f38aa464e923c30bb630c650e2021-11-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.121.022242https://doaj.org/toc/2047-9980Background 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.Kanta TanakaMasatoshi KogaKeon‐Joo LeeBeom Joon KimTadataka MizoguchiEun Lyeong ParkJuneyoung LeeSohei YoshimuraJae‐Kwan ChaByung‐Chul LeeJunpei KogeHee‐Joon BaeKazunori ToyodaWileyarticleatrial fibrillationechocardiographystrokeDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 22 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	atrial fibrillation echocardiography stroke Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	atrial fibrillation echocardiography stroke Diseases of the circulatory (Cardiovascular) system RC666-701 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
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.
format	article
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
title	Transesophageal Echocardiography in Ischemic Stroke With Atrial Fibrillation
title_short	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_sort	transesophageal echocardiography in ischemic stroke with atrial fibrillation
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/663f422f38aa464e923c30bb630c650e
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Transesophageal Echocardiography in Ischemic Stroke With Atrial Fibrillation

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