Predictors of Left Atrial Thrombi and Spontaneous Echocardiographic Contrast in the Acute Phase After Cardioembolic Stroke in Patients With Atrial Fibrillation

J Stroke Cerebrovasc Dis. 2019 Jun;28(6):1571-1577. doi: 10.1016/j.jstrokecerebrovasdis.2019.03.003. Epub 2019 Mar 29.

Abstract

Introduction: The underlying mechanism of the residual left atrial thrombus (LAT)/spontaneous echo contrast (SEC) after the onset of cardioembolic stroke (CES) is unknown. This study aims to investigate the utility of CHADS2 and CHA2DS2-VASc scores for predicting LAT/SEC, and to investigate the risk factors of residual LAT/SEC after CES onset.

Methods: This retrospective study included 124 patients who were admitted with the acute phase of CES at our center. The clinical, echocardiographic variables, the CHADS2/CHA2DS2-VASc scores, and National Institutes of Health Stroke Scale score were retrospectively assessed on admission.

Results: Of 124 patients, LAT or SEC was detected in 39 patients (31.5%, 17 LAT and 38 SEC). Univariate analysis showed that the LAT/SEC group had a higher prevalence of nonparoxysmal atrial fibrillation (AF), left ventricular (LV) hypertrophy, hypertension, the rate of anticoagulation before admission, higher National Institutes of Health Stroke Scale score, larger left atrial diameter, and elevated E wave. In contrast, the CHADS2 and CHA2DS2-VASc scores were not associated with LAT/SEC. LAT/SEC was associated with nonparoxysmal AF and LV hypertrophy on multivariate analysis. Moreover, all patients were divided into 4 groups based on the combination between non-paroxysmal AF and LV hypertrophy. The rate of LAT/SEC was the highest (87.5%) in patients with nonparoxysmal AF and LV hypertrophy.

Conclusions: Nonparoxysmal atrial fibrillation and left ventricular hypertrophy were associated with residual left atrial thrombus/spontaneous echo contrast in the acute phase after cardioembolic stroke that was independent of the CHADS2 and CHA2DS2-VASc scores.

Keywords: Atrial fibrillation; Left ventricular hypertrophy; Stroke; Thrombus.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation / diagnostic imaging*
  • Atrial Fibrillation / epidemiology
  • Cerebral Angiography
  • Databases, Factual
  • Disability Evaluation
  • Echocardiography, Transesophageal*
  • Electrocardiography
  • Female
  • Humans
  • Hypertrophy, Left Ventricular / diagnostic imaging*
  • Hypertrophy, Left Ventricular / epidemiology
  • Intracranial Embolism / diagnostic imaging
  • Intracranial Embolism / epidemiology*
  • Japan / epidemiology
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prevalence
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Stroke / diagnostic imaging
  • Stroke / epidemiology*
  • Thrombosis / diagnostic imaging*
  • Thrombosis / epidemiology