Feasibility of TEE-guided stroke risk assessment in atrial fibrillation—background, aims, design and baseline data of the TIARA pilot study
Antithrombotic management in atrial fibrillation (AF) is currently based on clinical characteristics, despite evidence of potential fine-tuning with transoesophageal echocardiography (TEE). This open, randomised, multicentre study addresses the hypothesis that a comprehensive strategy of TEE-based aspirin treatment in AF patients is feasible and safe.
Between 2005 and 2009, ten large hospitals in the Netherlands enrolled AF patients with a moderate risk of stroke. Patients without thrombogenic TEE characteristics were randomised to aspirin or vitamin K antagonists (VKA). The primary objective is to show that TEE-based aspirin treatment is safe compared with VKA therapy. The secondary objective tests feasibility of TEE as a tool to detect echocardiographic features of high stroke risk. This report compares randomised to non-randomised patients and describes the feasibility of a TEE-based approach.
In total, 310 patients were included. Sixty-nine patients were not randomised because of non-visualisation (n = 6) or TEE risk factors (n = 63). Compared with non-randomised patients, randomised patients (n = 241) were younger (65 ± 11 vs. 69 ± 9 years, p = 0.004), had less coronary artery disease (9 vs. 20%, p = 0.018), previous TIA (1.7 vs. 7.2%, p = 0.029), AF during TEE (25 vs. 54%, p < 0.001), mitral incompetence (55 vs. 70%, p = 0.038), VKA use (69 vs. 82%, p = 0.032), had a lower mean CHADS2 score (1.2 ± 0.6 vs. 1.6 ± 1.0, p = 0.004), and left ventricular ejection fraction (59 ± 8 vs. 56 ± 8%, p = 0.016).
This study shows that a TEE-based approach for fine-tuning stroke risk in AF patients with a moderate risk for stroke is feasible. Follow-up data will address the safety of this TEE-based approach.
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- Feasibility of TEE-guided stroke risk assessment in atrial fibrillation—background, aims, design and baseline data of the TIARA pilot study
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Netherlands Heart Journal
Volume 19, Issue 5 , pp 214-222
- Cover Date
- Print ISSN
- Online ISSN
- Bohn Stafleu van Loghum
- Additional Links
- Atrial fibrillation
- Stroke risk
- Antithrombotic treatment
- Author Affiliations
- 1. Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, the Netherlands
- 2. Department of Cardiology, Atrium Medical Center, Heerlen, the Netherlands
- 3. Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
- 4. Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
- 5. Department of Cardiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
- 6. Department of Cardiology, Martini Hospital Groningen, Groningen, the Netherlands
- 7. Department of Clinical Epidemiology, Maastricht University Medical Center, Maastricht, the Netherlands