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Transesophageal echocardiographic determinants of embolism in nonrheumatic atrial fibrillation

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Abstract

The purpose of the study was to determine the relation of transesophageal echocardiographic findings to symptoms of systemic embolism in patients with nonrheumatic atrial fibrillation. Transthoracic and transesophageal echocardiography were used to study 107 patients with atrial fibrillation including 49 patients without embolic complications and 58 patients who had suffered from previous cerebral or peripheral embolism. A multiple logistic regression analysis revealed that left atrial thrombi (odds ratio 9.0, 95% CI 2.4–33.6, p < 0.005) and the presence of dense left atrial spontaneous contrast (odds ratio 8.4, 95% CI 1.3–53.1, p < 0.05) were independently related to embolic symptoms. Intensive left atrial spontaneous contrast was associated with an increased left atrial diameter (odds ratio 2.0, 95% CI 1.1–3.6, p < 0.05), the presence of chronic atrial fibrillation (odds ratio 6.9, 95% CI 1.6–29.8, p < 0.01) and aortic atherosclerosis (odds ratio 2.6, 95% CI 1.2–5.5, p < 0.05). It was further negatively correlated to mitral regurgitation (odds ratio 0.4, 95% CI 0.2–0.9, p < 0.05). In conclusion, dense spontaneous echo contrast and left atrial thrombi are associated to thromboembolic complications in patients with nonrheumatic atrial fibrillation. Classifying of spontaneous contrast seems to be useful when estimating the thromboembolic risk in atrial fibrillation.

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References

  1. Campbell A, Caird FI, Jackson TFM. The prevalence of abnormalities of electrocardiogram in old people. Br Heart J 1974; 36: 1005–11.

    Google Scholar 

  2. Wolf PA, Dawber TR, Thomas HE, Kannel WB. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study. Neurology 1978; 28: 973–7.

    Google Scholar 

  3. Ezekowitz MD, Bridgers SL, James KE. Warfarin in the prevention of stroke associated with nonrheumatic atrial fibrillation. N Engl J Med 1992; 327: 1406–12.

    Google Scholar 

  4. Petersen P, Boysen G, Godtfredsen J, Andersen ED, Andersen B. Placebo-controlled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation. The Copenhagen AFASAK study. Lancet 1989; 1: 175–9.

    Google Scholar 

  5. Stroke Prevention in Atrial Fibrillation Investigators. Stroke prevention in atrial fibrillation study. Circulation 1991; 84: 527–39.

    Google Scholar 

  6. Stroke Prevention in Atrial Fibrillation Investigators. Predictors of thromboembolism in atrial fibrillation: II. Echocardiographic features of patients at risk. Ann Int Med 1992; 116: 6–12.

    Google Scholar 

  7. Petersen P, Kastrup J, Helweg-Larsen S, Boysen G, Godtfredsen J. Risk factors for thromboembolic complications in chronic atrial fibrillation. The Copenhagen AFASAK study. Arch Intern Med 1990; 150: 819–21.

    Google Scholar 

  8. Cabin HS, Clubb HS, Hall C, Perlmutter RA, Feinstein AR. Risk for systemic embolization of atrial fibrillation without mitral stenosis. Am J Cardiol 1990; 65: 1112–6.

    Google Scholar 

  9. Aschenberg W, Schlüter M, Kremer P, Schroeder E, Siglow V, Bleifeld W. Transesophageal echocardiography for the detection of left atrial appendage thrombus. J Am Coll Cardiol 1986; 7: 163–6.

    Google Scholar 

  10. Mügge A, Daniel WG, Hausmann D, Gödke J, Wagenbreth I, Lichtlen PR. Diagnosis of left atrial appendage thrombi by transesophageal echocardiography: Clinical applications and follow-up. Am J Cardiac Imaging 1990; 4: 173–9.

    Google Scholar 

  11. Daniel WG, Freedberg RS, Grote J et al. Incidence of left atrial thrombi in patients with nonvalvular atrial fibrillation — a multicenter study using transesophageal echocardiography (abstr). Circulation 1992; 86: 1–396.

    Google Scholar 

  12. Erbel R, Stern H, Ehrental W et al. Detection of spontaneous echocardiographic contrast within the left atrium by transesophageal echocardiography: Spontaneous echocardiographic contrast. Clin Cardiol 1986; 9: 245–52.

    Google Scholar 

  13. Chen YT, Kan MN, Chen JS et al. Contributing factors to formation of left atrial spontaneous echo contrast in mitral valvular disease. J Ultrasound Med 1990; 9: 151–5.

    Google Scholar 

  14. Iliceto S, Antonelli G, Sorino M, Biasco G, Rizzon P. Dynamic intracavitary left atrial echos in mitral stenosis. Am J Cardiol 1985; 55: 603–6.

    Google Scholar 

  15. Beppu S, Nimura Y, Sakakibara H, Nagata S, Park YD, Izumi S. Smoke-like echo in the left atrial cavity in mitral valve disease: Its features and significance. J Am Coll Cardiol 1985; 6: 744–9.

    Google Scholar 

  16. Daniel WG, Nellesen U, Schröder E et al. Left atrial spontaneous echo contrast in mitral valve disease: An indicator for an increased thromboembolic risk. J Am Coll Cardiol 1988; 11: 1204–11.

    Google Scholar 

  17. Sigel B, Coelho JCU, Spigos DG et al. Ultrasonography of blood during stasis and coagulation. Invest Radiol 1981; 16: 71–6.

    Google Scholar 

  18. Wolverson MK, Nouri S, Joist JH, Sundaram M, Heiberg E. The direct visualization of blood flow by real-time ultrasound: clinical observations and underlying mechanisms. Radiology 1981; 140: 443–8.

    Google Scholar 

  19. Wang XF, Liu L, Cheng TO, Li ZA, Deng YB, Wang JE. The relationship between intracardiovascular smokelike echo and erythrocyte rouleaux formation. Am Heart J 1992; 124: 961–4.

    Google Scholar 

  20. Merino A, Hauptman P, Badimon L et al. Echocardiographic ‘smoke’ is produced by an interaction of erythrocytes and plasma modulated by shear forces. J Am Coll Cardiol 1992; 20: 1661–8.

    Google Scholar 

  21. Black IW, Chesterman CN, Hopkins AP, Lee LCL, Chong BH, Walsh WE. Hematologic correlates of left atrial spontaneous echo contrast and thromboembolism in nonvalvular atrial fibrillation. J Am Coll Cardiol 1993; 21: 451–7.

    Google Scholar 

  22. Yoshida K, Yoshikawa J, Yamaura Y, Hozumi T, Akasaka T, Fukaya T. Assessment of mitral regurgitation by biplane transesophageal color Doppler flow mapping. Circulation 1990; 82: 1121–6.

    Google Scholar 

  23. Klein AL, Obarski TP, Steward WJ, Casale PN, Pearce GL, Husbands K, Cosgrove DM, Salcedo EE. Transesophageal Doppler echocardiography of pulmonary venous flow: A new marker of mitral regurgitation severity. J Am Coll Cardiol 1991; 18: 518–26.

    Google Scholar 

  24. Pearson AC, Nagelhout D, Castello R, Gomez CR, Labovitz AJ. Atrial septal aneurysm and stroke: a transesophageal echocardiographic study. J Am Coll Cardiol 1991; 18: 1223–9.

    Google Scholar 

  25. Sherman FS, Sahn DJ, Valdes-Druz LM, Chung KJ, Elias W. Two-dimensional Doppler color flow mapping for detecting atrial and ventricular septal defects. Herz 1987; 12: 212–6.

    Google Scholar 

  26. Sahn DJ, DeMaria A, Kisslo J, Weyman A. Recommendations regarding quantitation in M-Mode echocardiography: results of a survey of echocardiographic measurements. Circulation 1978; 58: 1072–83.

    Google Scholar 

  27. De Beider MA, Lovat LB, Tourikis L, Leech G, Camm A. Left atrial spontaneous contrast echoes — markers of thromboembolic risk in patients with atrial fibrillation. Eur Heart J 1993; 14: 326–35.

    Google Scholar 

  28. Black IW, Hopkins AP, Lee LCL, Walsh WE. Left atrial spontaneous echo contrast: A clinical and echocardiographic analysis. J Am Coll Cardiol 1991; 18: 398–404.

    Google Scholar 

  29. Tsai LM, Chen JH, Fang CJ, Lin LJ, Kwan CM. Clinical implications of left atrial spontaneous echo contrast in nonrheumatic atrial fibrillation. Am J Cardiol 1992; 70: 327–31.

    Google Scholar 

  30. Manning WJ, Silverman DI, Gordon SPF, Krumholz HM, Douglas PS. Cardioversion from atrial fibrillation without prolonged anticoagulation with use of transesophageal echocardiography to exclude the presence of atrial thrombi. N Engl J Med 1993; 328: 750–5.

    Google Scholar 

  31. Castello R, Pearson AC, Labovitz AJ. Prevalence and clinical implications of atrial spontaneous contrast in patients undergoing transesophageal echocardiography. Am J Cardiol 1990; 65: 1149–53.

    Google Scholar 

  32. Yuan YW, Shung KK. Ultrasonic backscatter from flowing whole blood. I: Dependence on shear rate and hematocrit. J Acoust Soc Am 1988; 84: 52–8.

    Google Scholar 

  33. Movsowitz C, Meyerowitz CB, Jacobs LE et al. Significant mitral regurgitation is protective against left atrial spontaneous echo contrast and thrombus as assessed by transesophageal echocardiography. J Am Soc Echocardiogr 1993; 6: 107–14.

    Google Scholar 

  34. Blackshear JL, Pearce LA, Asinger RW et al. Mitral regurgitation associated with reduced thromboembolic events in highrisk patients with nonrheumatic atrial fibrillation. Am J Cardiol 1993; 72: 840–3.

    Google Scholar 

  35. Gustafsson C, Blombäck M, Britton M, Hamsten A, Svensson J. Coagulation factors and the increased risk of stroke in nonvalvular atrial fibrillation. Stroke 1990; 21: 47–51.

    Google Scholar 

  36. Mitusch R, Garbe M, Siemens HJ, Sheikhzadeh A, Wagner T, Diederich KW. Elevated plasma levels of hemostatic markers indicating a prethrombotic state in nonrheumatic atrial fibrillation. In: Kessler CM, Rosengart A (eds). Hemostasis and Stroke. Boca Raton: CRC Press 1994: 37–41.

    Google Scholar 

  37. Hofmann T, Kasper W, Meinertz T, Geibel A, Just H. Echocardiographicevaluation of patients with clinically suspected arterial emboli. Lancet 1990; 336: 1421–4.

    Google Scholar 

  38. Mügge D, Daniel WG, Wenzlaff P et al. Patent foramen ovale or left atrial thrombi in unexplained arterial embolism. Lancet 1989; 1: 282–3.

    Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Medical University of Luebeck, Ratzeburger Allee 160, D-23538, Luebeck, Germany

    Rolf Mitusch, Verena Lange, Ulrich Stierle & Abdolhamid Sheikhzadeh

  2. Center of Rehabilitation Groβgmain-Salzburg, Salzburger Str. 520, A-5084, Groβgmain, Austria

    Barbara Maurer

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  1. Rolf Mitusch
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  2. Verena Lange
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  3. Ulrich Stierle
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  4. Barbara Maurer
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  5. Abdolhamid Sheikhzadeh
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Mitusch, R., Lange, V., Stierle, U. et al. Transesophageal echocardiographic determinants of embolism in nonrheumatic atrial fibrillation. Int J Cardiac Imag 11, 27–34 (1995). https://doi.org/10.1007/BF01148951

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