BACKGROUND: Atrial fibrillation (AF) is widely accepted as a direct cause of cardioembolic stroke from left atrial (LA) thrombus formation. However, the relationship between LA thrombus and transient ischemic attack (TIA) in patients with AF is less well established. METHODS: Two hundred sixty-one adult patients (mean age 66 +/- 11 years, 220 men and 41 women) with AF undergoing transesophageal echocardiography (TEE) were prospectively followed up for TIA (mean duration 30.3 +/- 20.6 months). RESULTS: LA thrombus was present in 18% (n = 46) and LA spontaneous echocardiographic contrast in 50% (n = 131) of the group. Nineteen of 261 patients had TIA during follow-up. Multivariate logistic regression showed congestive heart failure (CHF) as the only predictor of TIA when a model of clinical variables was constructed (odds ratio [OR] 2.7, P =.04). Age, sex, hypertension, and use of warfarin or aspirin were not predictors. When TEE variables were added to the model, LA thrombus became the only predictor of TIA (OR 7.7, P =.0001). Survival free of TIA (Kaplan-Meier) was significantly less (P =.0001) in patients with LA thrombus compared with those without, and the annual TIA event rate was 9.2% per year versus 1.9% per year (P <.0001), respectively. CONCLUSIONS: To our knowledge, this is the first prospective study documenting an association between LA thrombus and TIA in patients with AF. Other TEE variables, including aortic atheromata, and clinical parameters were not independently predictive. These data support a likely thromboembolic mechanism for TIA from LA thrombus in patients with AF.
BACKGROUND:Atrial fibrillation (AF) is widely accepted as a direct cause of cardioembolic stroke from left atrial (LA) thrombus formation. However, the relationship between LA thrombus and transient ischemic attack (TIA) in patients with AF is less well established. METHODS: Two hundred sixty-one adult patients (mean age 66 +/- 11 years, 220 men and 41 women) with AF undergoing transesophageal echocardiography (TEE) were prospectively followed up for TIA (mean duration 30.3 +/- 20.6 months). RESULTS: LA thrombus was present in 18% (n = 46) and LA spontaneous echocardiographic contrast in 50% (n = 131) of the group. Nineteen of 261 patients had TIA during follow-up. Multivariate logistic regression showed congestive heart failure (CHF) as the only predictor of TIA when a model of clinical variables was constructed (odds ratio [OR] 2.7, P =.04). Age, sex, hypertension, and use of warfarin or aspirin were not predictors. When TEE variables were added to the model, LA thrombus became the only predictor of TIA (OR 7.7, P =.0001). Survival free of TIA (Kaplan-Meier) was significantly less (P =.0001) in patients with LA thrombus compared with those without, and the annual TIA event rate was 9.2% per year versus 1.9% per year (P <.0001), respectively. CONCLUSIONS: To our knowledge, this is the first prospective study documenting an association between LA thrombus and TIA in patients with AF. Other TEE variables, including aortic atheromata, and clinical parameters were not independently predictive. These data support a likely thromboembolic mechanism for TIA from LA thrombus in patients with AF.
Authors: Marion Ferner; Daniel Wachtlin; Torsten Konrad; Oliver Deuster; Thomas Meinertz; Stephan von Bardeleben; Thomas Münzel; Monika Seibert-Grafe; Günter Breithardt; Thomas Rostock Journal: Clin Res Cardiol Date: 2015-06-25 Impact factor: 5.460
Authors: Kristina Wasmer; Julia Köbe; Dirk Dechering; Peter Milberg; Christian Pott; Julia Vogler; Jörg Stypmann; Johannes Waltenberger; Gerold Mönnig; Günter Breithardt; Lars Eckardt Journal: Clin Res Cardiol Date: 2012-09-15 Impact factor: 5.460
Authors: Antonio de Padua Mansur; Julio Yoshio Takada; Solange Desiree Avakian; Celia M C Strunz Journal: Clinics (Sao Paulo) Date: 2012 Impact factor: 2.365
Authors: Ethan D Borre; Adam Goode; Giselle Raitz; Bimal Shah; Angela Lowenstern; Ranee Chatterjee; Lauren Sharan; Nancy M Allen LaPointe; Roshini Yapa; J Kelly Davis; Kathryn Lallinger; Robyn Schmidt; Andrzej Kosinski; Sana M Al-Khatib; Gillian D Sanders Journal: Thromb Haemost Date: 2018-10-30 Impact factor: 6.681