Abstract
Background
Atrial fibrillation (AF), which is the most common etiology of cardioembolic stroke,
may be accompanied by other cardiac sources of embolism. The heterogeneity and multiplicity
of the cardiac sources of embolism may influence stroke severity via formation of
thrombi with heterogenous compositions, ages, and sizes. We investigated among stroke
patients with AF whether stroke severity is different between patients with concomitant
potential cardiac sources of embolism and those without.
Methods
The subjects for this study were consecutive patients with cerebral infarction and
AF who underwent transesophageal echocardiography during a 10-year period. The definitions
and determination of high- and medium-risk potential cardiac sources of embolism were
based on the Trial of Org 10172 in Acute Stroke Treatment classification. Initial
stroke severity and infarct sizes were compared between patients with concomitant
potential cardiac sources of embolism and those without.
Results
Of the 266 patients enrolled, 181 (68.0%) had one or more concomitant potential cardiac
sources of embolism. Left atrial thrombus and spontaneous echo contrast were most
common. Patients with concomitant potential cardiac sources of embolism had a higher
median score on the initial National Institute of Health Stroke Scale (6 vs. 3, p=0.005) and a larger infarction diameter (45.4±31.3 mm vs. 35.5±26.6 mm, p=0.002) than those without. Occlusion of the symptomatic arteries was more frequently
detected in patients with concomitant potential cardiac sources of embolism.
Conclusions
Stroke patients with AF frequently had concomitant potential cardiac sources of embolism,
and strokes were more severe in them.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Neurological SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Atrial fibrillation as a predictive factor for severe stroke and early death in 15,831 patients with acute ischaemic stroke.J Neurol Neurosurg Psychiatry. 2005; 76: 679-683
- Antithrombotic and thrombolytic therapy for ischemic stroke: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.Chest. 2004; 126: 483S-512S
- Subtyping of ischemic stroke based on vascular imaging: analysis of 1,167 acute, consecutive patients.J Clin Neurol. 2006; 2: 225-230
- Frequency and significance of cardiac sources of embolism in the TOAST classification.Cerebrovasc Dis. 2007; 24: 463-468
- Superiority of transesophageal echocardiography in detecting cardiac source of embolism in patients with cerebral ischemia of uncertain etiology.J Am Coll Cardiol. 1991; 17: 66-72
- Association of aortic plaque with intracranial atherosclerosis in patients with stroke.Neurology. 2006; 67: 1184-1188
- Patients with atrial fibrillation and dense spontaneous echo contrast at high risk a prospective and serial follow-up over 12 months with transesophageal echocardiography and cerebral magnetic resonance imaging.J Am Coll Cardiol. 2005; 45: 1807-1812
- Pathophysiologic correlates of thromboembolism in nonvalvular atrial fibrillation: II. Dense spontaneous echocardiographic contrast (The Stroke Prevention in Atrial Fibrillation [SPAF-III] study).J Am Soc Echocardiogr. 1999; 12: 1088-1096
- Transesophageal echocardiographic correlates of clinical risk of thromboembolism in nonvalvular atrial fibrillation. Stroke Prevention in Atrial Fibrillation III Investigators.J Am Coll Cardiol. 1998; 31: 1622-1626
- Yonsei Stroke Registry. Analysis of 1,000 patients with acute cerebral infarctions.Cerebrovasc Dis. 2001; 12: 145-151
- Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment.Stroke. 1993; 24: 35-41
- The impact of recanalization on ischemic stroke outcome: a meta-analysis.Stroke. 2007; 38: 967-973
- Heart and vessel pathology underlying brain infarction in 142 stroke patients.Ann Neurol. 2008; 63: 770-781
- Differential pattern of tissue plasminogen activator-induced proximal middle cerebral artery recanalization among stroke subtypes.Stroke. 2004; 35: 486-490
- Local intra-arterial thrombolysis in the carotid territory: does recanalization depend on the thromboembolus type?.Neuroradiology. 2002; 44: 695-699
- Left atrial appendage thrombus is not uncommon in patients with acute atrial fibrillation and a recent embolic event: a transesophageal echocardiographic study.J Am Coll Cardiol. 1995; 25: 452-459
- Mechanisms of thrombogenesis in atrial fibrillation: Virchow's triad revisited.Lancet. 2009; 373: 155-166
- Platelets and atrial fibrillation.Eur Heart J. 2001; 22: 2233-2242
- Predictors of left atrial spontaneous echo contrast and thrombi in patients with mitral stenosis and atrial fibrillation.Am J Cardiol. 2000; 86: 529-534
- Association of follow-up change of left atrial appendage blood flow velocity with spontaneous echo contrast in nonrheumatic atrial fibrillation.Chest. 2000; 117: 309-313
- Prediction of left atrial appendage thrombi in non-valvular atrial fibrillation.Eur Heart J. 2007; 28: 2217-2222
- The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-up Study.Am J Med. 1995; 98: 476-484
- Incidence of atrial fibrillation in an Italian population followed by their GPs through a telecardiology service.Int J Cardiol. 2005; 98: 215-220
- Left atrial and left atrial appendage functional abnormalities in patients with cardioembolic stroke in sinus rhythm and idiopathic atrial fibrillation.J Am Soc Echocardiogr. 1998; 11: 711-719
- Natural history of left atrial spontaneous echo contrast in nonrheumatic atrial fibrillation.Am J Cardiol. 1997; 80: 897-900
- Dabigatran versus warfarin in patients with atrial fibrillation.N Engl J Med. 2009; 361: 1139-1151
Article info
Publication history
Published online: September 14, 2010
Accepted:
August 6,
2010
Received in revised form:
July 5,
2010
Received:
April 26,
2010
Identification
Copyright
© 2010 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
