title: Prognostic value of trans-thoracic echocardiography in patients with acute stroke and atrial fibrillation: findings from the RAF study.
abstract: Anticoagulant therapy is recommended for the secondary prevention of stroke in patients with atrial fibrillation (AF). T he identification of patients at high risk for early recurrence, which are potential candidates to prompt anticoagulation, is crucial to justify the risk of bleeding associated with early anticoagulant treatment. The aim of this study was to evaluate in patients with acute ischemic stroke and AF the association between findings at trans-thoracic echocardiography (TTE) and 90 days recurrence. In consecutive patients with acute ischemic stroke and AF, TTE was performed within 7 days from hospital admission. Study outcomes were recurrent ischemic cerebrovascular events (stroke or TIA) and systemic embolism. 854 patients (mean age 76.3 ± 9.5 years) underwent a TTE evaluation; 63 patients (7.4%) had at least a study outcome event. Left atrial thrombosis was present in 11 patients (1.3%) among whom 1 had recurrent ischemic event. Left atrial enlargement was present in 548 patients (64.2%) among whom 51 (9.3%) had recurrent ischemic events. The recurrence rate in the 197 patients with severe left atrial enlargement was 11.7%. On multivariate analysis, the presence of atrial enlargement (OR 2.13; 95% CI 1.06-4.29, p = 0.033) and CHA2DS2-VASc score (OR 1.22; 95% CI 1.04-1.45, p = 0.018, for each point increase) were correlated with ischemic recurrences. In patients with AF-associated acute stroke, left atrial enlargement is an independent marker of recurrent stroke and systemic embolism. The risk of recurrence is accounted for by severe atrial enlargement. TTE-detected left atrial thrombosis is relatively uncommon.
authors.affiliation: Stroke Unit and Division of Cardiovascular Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Via G. Dottori 1, 06100, Perugia, Italy. maurizio.paciaroni@unipg.it.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Paciaroni
authors.affiliation: Stroke Unit and Division of Cardiovascular Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Via G. Dottori 1, 06100, Perugia, Italy.
authors.forename: Giancarlo
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authors.affiliation: Stroke Unit and Division of Cardiovascular Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Via G. Dottori 1, 06100, Perugia, Italy.
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authors.lastname: Falocci
authors.affiliation: Stroke Unit and Division of Cardiovascular Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Via G. Dottori 1, 06100, Perugia, Italy.
authors.forename: Valeria
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authors.lastname: Caso
authors.affiliation: Stroke Unit and Division of Cardiovascular Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Via G. Dottori 1, 06100, Perugia, Italy.
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authors.forename: Christina
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authors.affiliation: Neurology Unit, Department of Clinical and Experimental Sciences, University "Health and Wealth" of Brescia, Brescia, Italy.
authors.forename: Alessandro
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authors.affiliation: Neurology Unit, Department of Clinical and Experimental Sciences, University "Health and Wealth" of Brescia, Brescia, Italy.
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authors.affiliation: Neurology Unit, Department of Clinical and Experimental Sciences, University "Health and Wealth" of Brescia, Brescia, Italy.
authors.forename: Alessandro
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authors.affiliation: Stroke Unit, University of Debrecen, Debrecen, Hungary.
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authors.affiliation: Stroke Unit, University of Debrecen, Debrecen, Hungary.
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authors.affiliation: Department of Neurology, Keimyung University School of Medicine, Taegu, South Korea.
authors.forename: Sung-Il
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authors.affiliation: Centre Cérébrovasculaire, Service de Neurologie, Département des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois, Lausanne, Switzerland.
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authors.affiliation: Centre Cérébrovasculaire, Service de Neurologie, Département des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois, Lausanne, Switzerland.
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authors.affiliation: Stroke Unit and Division of Cardiovascular Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Via G. Dottori 1, 06100, Perugia, Italy.
authors.forename: Andrea
authors.initials: A
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authors.affiliation: Stroke Unit and Division of Cardiovascular Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Via G. Dottori 1, 06100, Perugia, Italy.
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authors.affiliation: Stroke Unit and Division of Cardiovascular Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Via G. Dottori 1, 06100, Perugia, Italy.
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authors.affiliation: Stroke Unit and Division of Cardiovascular Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Via G. Dottori 1, 06100, Perugia, Italy.
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authors.affiliation: Stroke Unit and Division of Cardiovascular Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Via G. Dottori 1, 06100, Perugia, Italy.
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authors.affiliation: Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.|Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Göteborg, Göteborg, Sweden.|Department of Neurology, Sahlgrenska University Hospital, Göteborg, Sweden.
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authors.affiliation: Department of Neurology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupoli, Greece.|International Clinic Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.|Second Department of Neurology, "Attikon" Hospital, University of Athens, School of Medicine, Athens, Greece.
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authors.affiliation: Department of Neurology, Hamad Medical Corporation, Doha, Qatar.
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mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000000981:diagnostic imaging*; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology / Q000517:prevention & control*
keywords: Acute stroke; Atrial fibrillation; Echocardiography; Outcome