title: A transesophageal echocardiographic study on risk factors for stroke in elderly patients with atrial fibrillation: a comparison with younger patients.
abstract: OBJECTIVE
  Atrial fibrillation (AF) becomes an increasingly important cause of stroke as patients get older. The aim of the study was to determine whether risk factors of cerebral embolism among elderly patients with AF differed from those of younger patients by using transesophageal echocardiography (TEE).
  
  
  METHODS
  Cross-sectional study at a university hospital.
  
  
  METHODS
  Cardiovascular lesions with the potential for thromboembolism in patients with AF were investigated using TEE. Left atrial spontaneous echocardiographic contrast (SEC), peak flow velocity in the left atrial appendage (LAA-flow), and aortic atherosclerosis of the thoracic aorta were assessed in 67 elderly (> or = 70 years old) and 135 younger (< 70 years old) patients. All patients underwent either brain CT (n = 54) or MRI (n = 148) to assess presence of cerebral infarction.
  
  
  RESULTS
  Cerebral infarction due to embolism was noted in 113 patients with AF. There was a higher prevalence of cerebral embolism in elderly patients when compared with younger patients (78% vs 45%; p < 0.001). Cerebral embolism found in younger patients was associated with high grade of SEC and lower LAA-flow (p < 0.05). In addition to these TEE findings, aortic atherosclerosis was more severe in elderly patients with cerebral embolism than in those without cerebral embolism (p < 0.0001). By multivariate logistic analysis, LAA-flow was an independent predictor of cortical infarction in younger patients, but not in elderly patients, whereas aortic atherosclerosis was a useful marker in predicting embolic risk in elderly patients.
  
  
  CONCLUSIONS
  TEE findings indicative of left atrial blood stasis were useful to identify the embolic risk of younger patients with AF, while atherosclerosis of the thoracic aorta appears to be an important marker for cerebral embolism in elderly patients.
authors.affiliation: Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, Toyama, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Shinokawa
authors.forename: T
authors.initials: T
authors.lastname: Hirai
authors.forename: S
authors.initials: S
authors.lastname: Takashima
authors.forename: T
authors.initials: T
authors.lastname: Kameyama
authors.forename: K
authors.initials: K
authors.lastname: Nakagawa
authors.forename: H
authors.initials: H
authors.lastname: Asanoi
authors.forename: H
authors.initials: H
authors.lastname: Inoue
mesh_terms: D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications*; D003430:Cross-Sectional Studies; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology*