Usefulness of Transesophageal Echocardiography for Predicting Covert Paroxysmal Atrial Fibrillation in Patients with Embolic Stroke of Undetermined Source
Background: Covert paroxysmal atrial fibrillation (CPAF) is a major cause of embolic stroke of undetermined source (ESUS). However, detecting PAF during hospitalization in these patients is difficult. Objectives: This study aimed to determine whether findings of transesophageal echocardiography (TEE...
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| Veröffentlicht in: | Cerebrovascular Diseases Extra 2019-09, Vol.9 (3), p.98-106 |
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| creator | Ohya, Yuichiro Osaki, Masato Fujimoto, Shigeru Jinnouchi, Juro Matsuki, Takayuki Mezuki, Satomi Kumamoto, Masaya Kanazawa, Makoto Tagawa, Naoki Ago, Tetsuro Kitazono, Takanari Arakawa, Shuji |
| description | Background: Covert paroxysmal atrial fibrillation (CPAF) is a major cause of embolic stroke of undetermined source (ESUS). However, detecting PAF during hospitalization in these patients is difficult. Objectives: This study aimed to determine whether findings of transesophageal echocardiography (TEE) during hospitalization are associated with later detection of PAF in patients with ESUS. Method: We retrospectively studied 348 patients with ESUS who were admitted to our hospital within 1 week of onset. These patients met the criteria of ESUS, underwent TEE during hospitalization, and were followed up for at least 1 year. Results: We found PAF in 35 (10.0%) patients. In patients with PAF, spontaneous echo contrast (SEC) and low left atrial appendage flow (LAAF) by TEE and enlargement of the left atrial dimension (LAD) by transthoracic echocardiography were identified more frequently compared with those who did not have PAF. In multivariate analysis, SEC and an LAD ≥42 mm were independently associated with later detection of PAF (p < 0.05). An association of LAAF |
| doi_str_mv | 10.1159/000502713 |
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However, detecting PAF during hospitalization in these patients is difficult. Objectives: This study aimed to determine whether findings of transesophageal echocardiography (TEE) during hospitalization are associated with later detection of PAF in patients with ESUS. Method: We retrospectively studied 348 patients with ESUS who were admitted to our hospital within 1 week of onset. These patients met the criteria of ESUS, underwent TEE during hospitalization, and were followed up for at least 1 year. Results: We found PAF in 35 (10.0%) patients. In patients with PAF, spontaneous echo contrast (SEC) and low left atrial appendage flow (LAAF) by TEE and enlargement of the left atrial dimension (LAD) by transthoracic echocardiography were identified more frequently compared with those who did not have PAF. In multivariate analysis, SEC and an LAD ≥42 mm were independently associated with later detection of PAF (p < 0.05). An association of LAAF <46.9 cm/s and PAF was marginal (p = 0.09). The specificity of the combined finding of SEC and/or LAAF with that of LAD increased up to 90%, while that of LAD alone was 70%. Conclusions: The findings of TEE during hospitalization may be useful for identifying patients at increased risk of CPAF in patients with ESUS.</description><identifier>ISSN: 1664-5456</identifier><identifier>EISSN: 1664-5456</identifier><identifier>DOI: 10.1159/000502713</identifier><identifier>PMID: 31542780</identifier><language>eng</language><publisher>Basel, Switzerland: S. Karger AG</publisher><subject>Aged ; Aged, 80 and over ; Aneurysms ; Anticoagulants ; Atrial Appendage - diagnostic imaging ; Atrial fibrillation ; Atrial Fibrillation - complications ; Atrial Fibrillation - diagnostic imaging ; Blood clots ; Blood pressure ; Cardiac arrhythmia ; Cardiology ; Cardiovascular disease ; Care and treatment ; Echocardiography ; Echocardiography, Transesophageal ; Embolic stroke of undetermined source ; Embolisms ; Female ; Fistula ; Heart ; Hospitalization ; Humans ; Intracranial Embolism - diagnostic imaging ; Intracranial Embolism - etiology ; Male ; Middle Aged ; Original Paper ; Pathogenesis ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Stroke ; Stroke - diagnostic imaging ; Stroke - etiology ; Time Factors ; Transesophageal echocardiography</subject><ispartof>Cerebrovascular Diseases Extra, 2019-09, Vol.9 (3), p.98-106</ispartof><rights>2019 The Author(s) Published by S. Karger AG, Basel</rights><rights>2019 The Author(s) Published by S. Karger AG, Basel.</rights><rights>COPYRIGHT 2019 S. Karger AG</rights><rights>Copyright © 2019 by S. Karger AG, Basel 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c585t-3280d8a37b6d3c7561570e13a9f1e21b6229db6115ff5515bc651051c2eef9883</citedby><cites>FETCH-LOGICAL-c585t-3280d8a37b6d3c7561570e13a9f1e21b6229db6115ff5515bc651051c2eef9883</cites><orcidid>0000-0003-4560-6594</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6787416/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6787416/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,27612,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31542780$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ohya, Yuichiro</creatorcontrib><creatorcontrib>Osaki, Masato</creatorcontrib><creatorcontrib>Fujimoto, Shigeru</creatorcontrib><creatorcontrib>Jinnouchi, Juro</creatorcontrib><creatorcontrib>Matsuki, Takayuki</creatorcontrib><creatorcontrib>Mezuki, Satomi</creatorcontrib><creatorcontrib>Kumamoto, Masaya</creatorcontrib><creatorcontrib>Kanazawa, Makoto</creatorcontrib><creatorcontrib>Tagawa, Naoki</creatorcontrib><creatorcontrib>Ago, Tetsuro</creatorcontrib><creatorcontrib>Kitazono, Takanari</creatorcontrib><creatorcontrib>Arakawa, Shuji</creatorcontrib><title>Usefulness of Transesophageal Echocardiography for Predicting Covert Paroxysmal Atrial Fibrillation in Patients with Embolic Stroke of Undetermined Source</title><title>Cerebrovascular Diseases Extra</title><addtitle>Cerebrovasc Dis Extra</addtitle><description>Background: Covert paroxysmal atrial fibrillation (CPAF) is a major cause of embolic stroke of undetermined source (ESUS). However, detecting PAF during hospitalization in these patients is difficult. Objectives: This study aimed to determine whether findings of transesophageal echocardiography (TEE) during hospitalization are associated with later detection of PAF in patients with ESUS. Method: We retrospectively studied 348 patients with ESUS who were admitted to our hospital within 1 week of onset. These patients met the criteria of ESUS, underwent TEE during hospitalization, and were followed up for at least 1 year. Results: We found PAF in 35 (10.0%) patients. In patients with PAF, spontaneous echo contrast (SEC) and low left atrial appendage flow (LAAF) by TEE and enlargement of the left atrial dimension (LAD) by transthoracic echocardiography were identified more frequently compared with those who did not have PAF. In multivariate analysis, SEC and an LAD ≥42 mm were independently associated with later detection of PAF (p < 0.05). An association of LAAF <46.9 cm/s and PAF was marginal (p = 0.09). The specificity of the combined finding of SEC and/or LAAF with that of LAD increased up to 90%, while that of LAD alone was 70%. Conclusions: The findings of TEE during hospitalization may be useful for identifying patients at increased risk of CPAF in patients with ESUS.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aneurysms</subject><subject>Anticoagulants</subject><subject>Atrial Appendage - diagnostic imaging</subject><subject>Atrial fibrillation</subject><subject>Atrial Fibrillation - complications</subject><subject>Atrial Fibrillation - diagnostic imaging</subject><subject>Blood clots</subject><subject>Blood pressure</subject><subject>Cardiac arrhythmia</subject><subject>Cardiology</subject><subject>Cardiovascular disease</subject><subject>Care and treatment</subject><subject>Echocardiography</subject><subject>Echocardiography, Transesophageal</subject><subject>Embolic stroke of undetermined source</subject><subject>Embolisms</subject><subject>Female</subject><subject>Fistula</subject><subject>Heart</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Intracranial Embolism - diagnostic imaging</subject><subject>Intracranial Embolism - etiology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Original Paper</subject><subject>Pathogenesis</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Stroke</subject><subject>Stroke - diagnostic imaging</subject><subject>Stroke - etiology</subject><subject>Time Factors</subject><subject>Transesophageal echocardiography</subject><issn>1664-5456</issn><issn>1664-5456</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>M--</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNptkk1vEzEQhlcIRKvSA3eEVuIChxR7vf7YC1IUpVCpEpXanC2vPd443bWDvSnkr_BrcUgILUI-2Bo_887MqymK1xhdYEybjwghiiqOybPiFDNWT2hN2fNH75PiPKVVxhBDmDT4ZXFCMK0rLtBp8XORwG56DymVwZZ3UfkEKayXqgPVl3O9DFpF40IX1Xq5LW2I5U0E4_TofFfOwgPEsbxRMfzYpiFnTMfo8nXp2uj6Xo0u-NL5TIwO_JjK725clvOhDb3T5e0Ywz3sCi-8gRHi4DyY8jZsooZXxQur-gTnh_usWFzO72ZfJtdfP1_NptcTTQUdJ6QSyAhFeMsM0ZwyTDkCTFRjMVS4ZVXVmJZlr6ylFNNWM4oRxboCsI0Q5Ky42uuaoFZyHd2g4lYG5eTvQIidVHF0ugdpqQbMcSOssLVgbcsJoUC5RaIWxkDW-rTXWm_aAYzOI0fVPxF9-uPdUnbhQTIueI1ZFnh_EIjh2wbSKAeXNGQnPYRNknkYhgnHbNf3u3_QVfbNZ6tkRRBuMKl5lamLPdWpPIDzNuS6Oh8Dg9PBg3U5PmUEiaZCVZ0TPuwTdAwpRbDH7jGSu42Tx43L7NvH4x7JP_v1t8d7FTuIR2A2n-8l5NrYTL35L3Wo8guZuOcd</recordid><startdate>20190901</startdate><enddate>20190901</enddate><creator>Ohya, Yuichiro</creator><creator>Osaki, Masato</creator><creator>Fujimoto, Shigeru</creator><creator>Jinnouchi, Juro</creator><creator>Matsuki, Takayuki</creator><creator>Mezuki, Satomi</creator><creator>Kumamoto, Masaya</creator><creator>Kanazawa, Makoto</creator><creator>Tagawa, Naoki</creator><creator>Ago, Tetsuro</creator><creator>Kitazono, Takanari</creator><creator>Arakawa, Shuji</creator><general>S. Karger AG</general><general>Karger Publishers</general><scope>M--</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IAO</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-4560-6594</orcidid></search><sort><creationdate>20190901</creationdate><title>Usefulness of Transesophageal Echocardiography for Predicting Covert Paroxysmal Atrial Fibrillation in Patients with Embolic Stroke of Undetermined Source</title><author>Ohya, Yuichiro ; Osaki, Masato ; Fujimoto, Shigeru ; Jinnouchi, Juro ; Matsuki, Takayuki ; Mezuki, Satomi ; Kumamoto, Masaya ; Kanazawa, Makoto ; Tagawa, Naoki ; Ago, Tetsuro ; Kitazono, Takanari ; Arakawa, Shuji</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c585t-3280d8a37b6d3c7561570e13a9f1e21b6229db6115ff5515bc651051c2eef9883</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aneurysms</topic><topic>Anticoagulants</topic><topic>Atrial Appendage - diagnostic imaging</topic><topic>Atrial fibrillation</topic><topic>Atrial Fibrillation - complications</topic><topic>Atrial Fibrillation - diagnostic imaging</topic><topic>Blood clots</topic><topic>Blood pressure</topic><topic>Cardiac arrhythmia</topic><topic>Cardiology</topic><topic>Cardiovascular disease</topic><topic>Care and treatment</topic><topic>Echocardiography</topic><topic>Echocardiography, Transesophageal</topic><topic>Embolic stroke of undetermined source</topic><topic>Embolisms</topic><topic>Female</topic><topic>Fistula</topic><topic>Heart</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Intracranial Embolism - diagnostic imaging</topic><topic>Intracranial Embolism - etiology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Original Paper</topic><topic>Pathogenesis</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Stroke</topic><topic>Stroke - diagnostic imaging</topic><topic>Stroke - etiology</topic><topic>Time Factors</topic><topic>Transesophageal echocardiography</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ohya, Yuichiro</creatorcontrib><creatorcontrib>Osaki, Masato</creatorcontrib><creatorcontrib>Fujimoto, Shigeru</creatorcontrib><creatorcontrib>Jinnouchi, Juro</creatorcontrib><creatorcontrib>Matsuki, Takayuki</creatorcontrib><creatorcontrib>Mezuki, Satomi</creatorcontrib><creatorcontrib>Kumamoto, Masaya</creatorcontrib><creatorcontrib>Kanazawa, Makoto</creatorcontrib><creatorcontrib>Tagawa, Naoki</creatorcontrib><creatorcontrib>Ago, Tetsuro</creatorcontrib><creatorcontrib>Kitazono, Takanari</creatorcontrib><creatorcontrib>Arakawa, Shuji</creatorcontrib><collection>Karger Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale Academic OneFile</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Cerebrovascular Diseases Extra</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ohya, Yuichiro</au><au>Osaki, Masato</au><au>Fujimoto, Shigeru</au><au>Jinnouchi, Juro</au><au>Matsuki, Takayuki</au><au>Mezuki, Satomi</au><au>Kumamoto, Masaya</au><au>Kanazawa, Makoto</au><au>Tagawa, Naoki</au><au>Ago, Tetsuro</au><au>Kitazono, Takanari</au><au>Arakawa, Shuji</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Usefulness of Transesophageal Echocardiography for Predicting Covert Paroxysmal Atrial Fibrillation in Patients with Embolic Stroke of Undetermined Source</atitle><jtitle>Cerebrovascular Diseases Extra</jtitle><addtitle>Cerebrovasc Dis Extra</addtitle><date>2019-09-01</date><risdate>2019</risdate><volume>9</volume><issue>3</issue><spage>98</spage><epage>106</epage><pages>98-106</pages><issn>1664-5456</issn><eissn>1664-5456</eissn><abstract>Background: Covert paroxysmal atrial fibrillation (CPAF) is a major cause of embolic stroke of undetermined source (ESUS). However, detecting PAF during hospitalization in these patients is difficult. Objectives: This study aimed to determine whether findings of transesophageal echocardiography (TEE) during hospitalization are associated with later detection of PAF in patients with ESUS. Method: We retrospectively studied 348 patients with ESUS who were admitted to our hospital within 1 week of onset. These patients met the criteria of ESUS, underwent TEE during hospitalization, and were followed up for at least 1 year. Results: We found PAF in 35 (10.0%) patients. In patients with PAF, spontaneous echo contrast (SEC) and low left atrial appendage flow (LAAF) by TEE and enlargement of the left atrial dimension (LAD) by transthoracic echocardiography were identified more frequently compared with those who did not have PAF. In multivariate analysis, SEC and an LAD ≥42 mm were independently associated with later detection of PAF (p < 0.05). An association of LAAF <46.9 cm/s and PAF was marginal (p = 0.09). The specificity of the combined finding of SEC and/or LAAF with that of LAD increased up to 90%, while that of LAD alone was 70%. Conclusions: The findings of TEE during hospitalization may be useful for identifying patients at increased risk of CPAF in patients with ESUS.</abstract><cop>Basel, Switzerland</cop><pub>S. Karger AG</pub><pmid>31542780</pmid><doi>10.1159/000502713</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-4560-6594</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Aneurysms Anticoagulants Atrial Appendage - diagnostic imaging Atrial fibrillation Atrial Fibrillation - complications Atrial Fibrillation - diagnostic imaging Blood clots Blood pressure Cardiac arrhythmia Cardiology Cardiovascular disease Care and treatment Echocardiography Echocardiography, Transesophageal Embolic stroke of undetermined source Embolisms Female Fistula Heart Hospitalization Humans Intracranial Embolism - diagnostic imaging Intracranial Embolism - etiology Male Middle Aged Original Paper Pathogenesis Predictive Value of Tests Prognosis Retrospective Studies Risk Assessment Risk Factors Stroke Stroke - diagnostic imaging Stroke - etiology Time Factors Transesophageal echocardiography |
| title | Usefulness of Transesophageal Echocardiography for Predicting Covert Paroxysmal Atrial Fibrillation in Patients with Embolic Stroke of Undetermined Source |
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