title: Effect of mitral regurgitation on cerebrovascular accidents in patients with atrial fibrillation and left atrial thrombus.
abstract: BACKGROUND
  The effect of mitral regurgitation (MR) on the incidence of new cerebrovascular accidents (CVA) and mortality in patients with atrial fibrillation (AF) and left atrial thrombus (LAT) is unknown.
  
  
  OBJECTIVE
  To investigate the effect of MR in patients with AF and LAT on new CVA and mortality.
  
  
  METHODS
  Eighty nine consecutive patients, mean age 71 years, with AF and LAT documented by transesophageal echocardiography were investigated to determine the prevalence and severity of MR and the association of the severity of MR with new cerebrovascular accidents (CVA) and mortality at 34-mo follow-up.
  
  
  RESULTS
  Of 89 patients, 1 + MR was present in 23 patients (26%), 2 + MR in 44 patients (50%), 3 + MR in 17 patients (19%), and 4 + MR in 3 patients (4%). Mean follow-up was 34 +/- 28 mo. The Cox proportional hazards model showed that the severity of increased MR did not significantly increase new CVA or mortality at 34-mo follow-up. The only variable predictive of mortality was left ventricular ejection fraction (LVEF), and with every unit increase in LVEF, the risk decreased by 3%.
  
  
  CONCLUSIONS
  MR occurred in 87 of 89 patients (98%) with AF and LAT. There was no association between the severity of MR and the incidence of CVA or mortality.
authors.affiliation: Cardiac Center of Creighton University, Omaha, Nebraska, USA.
authors.forename: Chandra K
authors.initials: CK
authors.lastname: Nair
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.forename: Xuedong
authors.initials: X
authors.lastname: Shen
authors.forename: Kishlay
authors.initials: K
authors.lastname: Anand
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Holmberg
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Esterbrooks
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D018618:Echocardiography, Doppler, Color; D018619:Echocardiography, Doppler, Pulsed; D017548:Echocardiography, Transesophageal; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D013318:Stroke Volume; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D013997:Time Factors; D016277:Ventricular Function, Left