Document Detail

Atrial fibrillation - patients at high risk for cerebral embolism.
MedLine Citation:
PMID:  16598527     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Patients with atrial fibrillation (AF) have a risk of cerebral embolism. Echocardiographic parameters elevate this risk significantly. However, there is little knowledge about the long-term fate and the rate of clinically silent cerebral embolism under continued oral anticoagulation. The aims of our study were to assess prognosis of patients with AF and determine a high risk group with an increased risk of cerebral embolism under oral anticoagulation. METHODS: Consecutive patients with persistent or permanent AF and left atrial (LA) thrombi, dense spontaneous echo contrast (SEC) and/or reduced LA appendage peak emptying velocities (LAAv) were included in the study (N = 128). Patients with AF and without echocardiographic risk factors (N = 114) served as controls. All patients were examined with transesophageal echocardiography, cranial magnetic resonance imaging and clinically during a period of three years. RESULTS: During the three-year follow-up period 6 (5%) of the high risk patients had cerebral embolism with neurological deficits. 4 (3%) patients died due to embolic events and 17 (13%) patients had silent embolism as documented on MRI. In the control group 8 (7%) patients had embolic events (n = 1 clinically apparent and n = 7 silent embolism) documented on MRI, one was clinically apparent. Study patients with an event had more commonly previous thromboembolism (p < 0.0001). CONCLUSIONS: Patients with peristent or permanent AF and LA thrombi, dense SEC or reduced LAAv have an explicitly increased risk of cerebral embolism (21%) despite oral anticoagulation. Previous thromboembolic event is another important predictor for an event.
P Bernhardt; H Schmidt; T Sommer; B Lüderitz; H Omran
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Publication Detail:
Type:  Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't     Date:  2006-01-12
Journal Detail:
Title:  Clinical research in cardiology : official journal of the German Cardiac Society     Volume:  95     ISSN:  1861-0684     ISO Abbreviation:  -     Publication Date:  2006 Mar 
Date Detail:
Created Date:  2006-04-06     Completed Date:  2006-05-10     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  101264123     Medline TA:  Clin Res Cardiol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  148-53     Citation Subset:  IM    
Department of Medicine-Cardiology, University of Bonn, Germany.
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MeSH Terms
Atrial Fibrillation / epidemiology*,  ultrasonography*
Echocardiography, Transesophageal / statistics & numerical data
Intracranial Embolism / diagnosis*,  epidemiology*
Magnetic Resonance Imaging / statistics & numerical data
Middle Aged
Risk Assessment / methods*
Risk Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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