Hideyuki Kishima1, Takanao Mine2, Eiji Fukuhara2, Kenki Ashida2, Kazutaka Uchida3, Shinichi Yoshimura3, Masaharu Ishihara2. 1. Department of Internal Medicine, Cardiovascular Division, Hyogo College of Medicine, Nishinomiya, Japan. Electronic address: kishima@hyo-med.ac.jp. 2. Department of Internal Medicine, Cardiovascular Division, Hyogo College of Medicine, Nishinomiya, Japan. 3. Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan.
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.
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.