title: Transesophageal echocardiographic findings are independent and relevant predictors of ischemic stroke in patients with nonvalvular atrial fibrillation.
abstract: OBJECTIVE
  Not only clinical factors, including the CHADS(2) score, but also echocardiographic findings have been reported to be useful for predicting the risk of ischemic stroke in patients with nonvalvular atrial fibrillation (NVAF). However, it remains to be determined which of these factors might be more relevant for evaluation of the risk of stroke in each patient.
  
  
  METHODS
  In 490 patients with NVAF who underwent transesophageal echocardiography (TEE), we examined the long-term incidence of ischemic stroke events (mean follow-up time, 5.7±3.3 years). For each patient, the predictive values of gender, the CHADS(2) risk factors (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, history of cerebral ischemia), the CHADS(2) score, and the findings on echocardiography, including TEE risk markers, were assessed.
  
  
  RESULTS
  The ischemic stroke rate was significantly correlated with the CHADS(2) score (p<0.05). According to the results of univariate analyses, age ≥75 years, history of cerebral ischemia, CHADS(2) score ≥2, and presence of TEE risk were significantly correlated with the incidence of ischemic stroke. Cox proportional hazards regression analyses identified age ≥75 years and presence of TEE risk as significant predictors of subsequent ischemic stroke events in patients with NVAF. As compared with that in persons below 75 years of age without TEE risk, the ischemic stroke rate was significantly higher in persons who were ≥75 years of age with TEE risk (4.3 vs. 0.56%/year, adjusted hazard ratio=8.94, p<0.001).
  
  
  CONCLUSIONS
  TEE findings might be more relevant predictors of ischemic stroke than the CHADS(2) score in patients with NVAF. The stroke risk was more than 8-fold higher in patients aged ≥75 years with TEE risk.
authors.affiliation: Department of Neurology, Toyama University Hospital, Toyama, Japan.
authors.forename: Shutaro
authors.initials: S
authors.lastname: Takashima
authors.forename: Keiko
authors.initials: K
authors.lastname: Nakagawa
authors.forename: Tadakazu
authors.initials: T
authors.lastname: Hirai
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Dougu
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Taguchi
authors.forename: Etsuko
authors.initials: E
authors.lastname: Sasahara
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Ohara
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Fukuda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Inoue
authors.forename: Kortaro
authors.initials: K
authors.lastname: Tanaka
keywords: atrial fibrillation; risk; stroke; transesophageal echocardiography