Summary
We investigated the relationship between left atrial spontaneous echo contrast (SEC) and cerebrovascular features in nonvalvular atrial fibrillation (NVAF). Few reports have been published to compare cardiac and cerebrovascular imaging in patients with NVAF. Forty-four patients with NVAF were studied using transesophageal echocardiography and noninvasive imaging including magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and transcranial color Doppler imaging (TCD) in the middle cerebral artery (MCA) territory. The symptomatic severity was divided into asymptomatic, transient ischemic attack (TIA), and stroke. The severity of the MRI findings was divided into normal, small, and large infarcts. The severity of the MRA findings was divided into normal, attenuation, and occlusion. MCA was bilaterally scanned and a side-to-side asymmetry ratio of pulsatility index (PI) was measured. The severity of SEC was divided into normal, SEC, and thrombi. Five patients with other thromboembolic risk or poor results of TCD were excluded. SEC and thrombi were detected in 12 (30%) and in 3 patients (5%), respectively. TIA and stroke were detected in 8 (21%) and in 17 patients (44%), respectively. Small and large infarcts were detected in 9 (23%) and in 18 patients (46%), respectively, on MRI. Attenuation and occlusion were detected in 14 (36%) and in 8 patients (21%), respectively, on MRA. PI ratio was 1.21 ± 0.25. SEC severity was highly associated with PI ratio and MRA severity in monovariate analysis (P < 0.005),P < 0.01, respectively). SEC severity was highly associated with PI ratio and MRA severity in stepwise multiple regression analysis (P = 0.0001,r = 0.630,n = 39). In patients with NVAF, left atrial SEC was highly related to attenuation or occlusion on MRA and imbalance of cerebral blood flow on TCD in the MCA territory.
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References
Stroke Prevention in Atrial Fibrillation Investigators (1991) Stroke prevention in atrial fibrillation study. Circulation 84:527–539
European Atrial Fibrillation Trial Study Group (1993) Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. Lancet 342:1225–1263
Jorgensen HS, Nakayama H, Reith J, Raaschou HO, Olsen TS (1996) Acute stroke with atrial fibrillation. The Copenhagen stroke study. Stroke 27:1765–1769
Wolf PA, Abbott RD, Kannel WB (1991) Atrial fibrillation as an independent risk factor for stroke: the Framingham study. Stroke 22:983–988
Stroke Prevention in Atrial Fibrillation Investigators (1992) Predictors of thromboembolism in atrial fibrillation: I. Clinical features of patients at risk. Ann Intern Med 116:1–5
Tsai LM, Chen JH, Lin LJ, Teng JU (1997) Natural history of left atrial spontaneous echo contrast in nonrheumatic atrial fibrillation. Am J Cardiol 80:897–900
Stroke Prevention in Atrial Fibrillation Investigators (1992) Predictors of thromboembolism in atrial fibrillation: II. Echocardiographic features of patients at risk. Ann Intern Med 116:6–12
Chimowitz MI, DeGeorgia MA, Poole RM, Hepner A, Armstrong WA (1993) Left atrial spontaneous echo contrast is highly associated with previous stroke in patients with atrial fibrillation or mitral stenosis. Stroke 24:1015–1019
Black IW, Fatkin D, Sagar KB, Khandheria BK, Leung DY, Galloway JM, Feneley MP, Walsh WF, Grimm RA, Stollberger C (1994) Exclusion of atrial thrombus by transesophageal echocardiography does not preclude embolism after cardioversion of atrial fibrillation. Circulation 89:2509–2513
Pohjasvaara T, Erkinjuntti T, Vataja R, Kaste M (1997) Comparison of stroke features and disability in daily life in patients with ischemic stroke aged 55 to 70 and 71 to 85 years. Stroke 28:729–735
Black IW, Hopkins A, Lee LC, Walsh WF (1991) Left atrial spontneous echo contrast: a clinical and echocardiographic analysis. J Am Coll Cardiol 18:398–404
Fillenbaum GG, George LK, Blazer DG (1988) Scoring nonresponse on the Mini-Mental State Examination. Psychol Med 18:1021–1025
Fuster V, Verstraete M (1997) Hemostasis, thrombosis, fibrinolysis and cardiovascular disease. In: Braunwald (ed) Heart disease, 5th edn. Saunders, Philadelphia, pp 1830–1832
Heinsius T, Bogousslavsky, Van Melle G (1998) Large infarcts in the middle cerebral artery territory. Etiology and outcome patterns. Neurology 50:341–350
Otis SM, Ringelstein EB (1996) The transcranial Doppler examination: principles and applications of transcranial Doppler sonology. In: Tegeler CH, Babikian VL, Gomez CR (eds) Neurosonology. Mosby, St. Louis, pp 113–128
Saunders DE, Clifton AG, Brown MM (1995) Measurement of infarct size using MRI predicts prognosis in middle cerebral artery infarction. Stroke 26:2272–2276
Kenton AR, Martin PJ, Abbott RJ, Moody AR (1997) Comparison of transcranial color-coded sonography and magnetic resonance angiography in acute stroke. Stroke 28:1601–1606
Baumgartner RW, Arnold M, Gonner F, Staikow I, Herrmann C, Rivoir A, Muri RM (1997) Contrastenhanced transcranial color-coded duplex sonography in ischemic cerebrovascular disease. Stroke 28:2473–2478
Knappertz VA, Tegeler CH (1996) Color flow imaging. In: Tegeler CH, Babikian VL, Gomez CR (eds) Neurosonology. Mosby, St. Louis, pp 113–128
Zbornikova V (1997) Different flow patterns in infarction of the middle cerebral artery. J Neuroimag 7:69–77
Mayer SA, Thomas CE, Diamond BE (1996) Asymmetry of intracranial hemodynamics as an indicator of mass effect in acute intracerebral hemorrhage. A transcranial Doppler study. Stroke 27:1788–1792
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Kochi, K., Kanehiro, K., Mukada, K. et al. Relationship between left atrial spontaneous echo contrast and the features of middle cerebral artery territory in nonvalvular atrial fibrillation. Heart Vessels 14, 149–153 (1999). https://doi.org/10.1007/BF02482299
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DOI: https://doi.org/10.1007/BF02482299