Predictors of left atrial spontaneous echocardiographic contrast or thrombus formation in stroke patients with sinus rhythm and reduced left ventricular function.
The objective of the present study was to identify predictors of left atrial spontaneous echocardiographic contrast (SEC) or thrombus in patients with stroke with sinus rhythm and left ventricular dysfunction. Of 500 consecutive patients with stroke, 48 with sinus rhythm and reduced left ventricular ejection fractions (EFs) < or =45% were examined. Ten patients presented with SEC or thrombus. The patients with SEC or thrombus had larger left atrial diameters (47 +/- 4 vs 42 +/- 6 mm, p <0.05), smaller EFs (30 +/- 9% vs 38 +/- 8%, p <0.01), and slower left atrial appendage (LAA) flow velocities (42 +/- 13 vs 61 +/- 17 cm/s, p <0.01). Multivariate analysis identified EF < or =35% and LAA flow velocity < or =55 cm/s as predictors of SEC or thrombus (p <0.05). Patients with stroke with sinus rhythm and moderate- to high-grade reduction of the left ventricular EF represent a risk group for a left atrial source of embolism and should undergo transesophageal echocardiography.
Handke
Michael
M
Department of Cardiology and Angiology, Freiburg, Germany. handke@mm31.ukl.uni-freiburg.de
Harloff
Andreas
A
Hetzel
Andreas
A
Olschewski
Manfred
M
Bode
Christoph
C
Geibel
Annette
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003287:Contrast Media / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D020521:Stroke / Q000150:complications*; D013318:Stroke Volume / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology
D003287:Contrast Media