Document Detail


Clinical predictors of left atrial thrombus and spontaneous echocardiographic contrast in patients with atrial fibrillation.
MedLine Citation:
PMID:  17566700     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We sought to determine the relationship between clinical risk factors for systemic thromboembolism in patients with atrial fibrillation and the prevalence of left atrial (LA) spontaneous echocontrast (SEC) and LA thrombus (LAT).
BACKGROUND: Atrial fibrillation is associated with an increased risk of systemic thromboembolism. LA SEC and LAT also predict thromboembolic events. The relationship between clinical risk factors for systemic thromboembolism and prevalence of LA SEC and LAT is unknown.
METHODS: In all, 524 patients with atrial fibrillation underwent transesophageal echocardiography between August 2000 and March 2005. Clinical risk factors for systemic thromboembolism were determined for each patient. A CHADS(2) score ranging from 0 to 6 was calculated for each patient as: congestive heart failure = 1 point; hypertension = 1 point; age 75 years or older = 1 point; diabetes mellitus = 1 point; and history of stroke including transient ischemic attack or systemic embolism = 2 points. Transesophageal echocardiography reports were reviewed for the presence of LA SEC and LAT. Univariate and multivariable models were structured to assess which clinical risk factors predicted the presence of LA SEC or LAT.
RESULTS: In a multivariable model, age 75 years or older, previous thromboembolic event, and left ventricular ejection fraction (LVEF) less than 40% predicted LA SEC, whereas LVEF less than 40% was the only predictor of LAT. LA SEC was present in 24% of patients with a CHADS(2) score of 0, but was present in 58% with a CHADS(2) score of 5 or 6 (P < .0001). LAT was present in 3% percent of patients with a CHADS(2) score of 0, but in 17% of patients with a CHADS(2) score of 5 or 6 (P = .0026).
CONCLUSION: Age 75 years or older, previous thromboembolic event, and LVEF less than 40% predict presence of LA SEC. LVEF less than 40% is the only multivariate predictor of LAT. The prevalence of LA SEC and LAT increases with increasing CHADS(2) score.
Authors:
Valerie J Rader; Taiyeb M Khumri; Madhuri Idupulapati; Casey N Stoner; Anthony Magalski; Michael L Main
Publication Detail:
Type:  Journal Article     Date:  2007-06-12
Journal Detail:
Title:  Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography     Volume:  20     ISSN:  1097-6795     ISO Abbreviation:  J Am Soc Echocardiogr     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-10-02     Completed Date:  2007-10-18     Revised Date:  2011-06-10    
Medline Journal Info:
Nlm Unique ID:  8801388     Medline TA:  J Am Soc Echocardiogr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1181-5     Citation Subset:  IM    
Affiliation:
Mid America Heart Institute, Kansas City, Missouri, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Aged
Atrial Fibrillation / complications*,  physiopathology,  ultrasonography
Echocardiography, Doppler, Color / methods
Echocardiography, Transesophageal / methods*
Female
Follow-Up Studies
Heart Atria*
Heart Diseases / etiology,  physiopathology,  ultrasonography*
Humans
Male
Prognosis
Retrospective Studies
Risk Factors
Severity of Illness Index
Stroke Volume / physiology
Thrombosis / etiology,  physiopathology,  ultrasonography*
Ventricular Function, Left / physiology*
Comments/Corrections
Comment In:
J Am Soc Echocardiogr. 2011 May;24(5):520-5   [PMID:  21514502 ]

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


Previous Document:  Noninvasive assessment of pulmonary vascular resistance using Doppler tissue imaging of the tricuspi...
Next Document:  Evaluation of left ventricular contractile function using noninvasively determined single-beat end-s...