What question did this study set out to answer?

To assess whether transesophageal echocardiographic findings correlate with stroke or embolism in patients with nonrheumatic atrial fibrillation.

April 15, 1998Annals of Internal Medicine

Transesophageal Echocardiography To Assess Embolic Risk in Patients with Atrial Fibrillation

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Why the study?

Does transesophageal echocardiography assessment of embolic risk predict stroke or embolism better than clinical history in outpatients with nonrheumatic atrial fibrillation?

Population

409 outpatients with nonrheumatic atrial fibrillation and without recent stroke.

Design

Cohort

Follow-up

range 1 to 74 months (mean, 58 months)

Authors

CSClaudia StöllbergerHeart Failure / Cardiomyopathy

Discussion

Member takes

Implication

Clinical factors may outperform TEE for embolic risk stratification in nonrheumatic AF; hypothesis-generating and should not yet change practice.

Key Points

To assess whether transesophageal echocardiographic findings correlate with stroke or embolism in patients with nonrheumatic atrial fibrillation.
Multicenter observational follow-up study of 409 outpatients with nonrheumatic atrial fibrillation and without recent stroke across hospitals in Austria and Slovakia.
Patients with detected thrombi received anticoagulation therapy, whereas patients without thrombi were treated with aspirin.
Follow-up ranged from 1 to 74 months (mean 58 months) to monitor for primary events of stroke or embolism.
In univariate analysis, stroke or embolism was significantly associated with thrombi (RR 3.9, 95% CI 1.4–10.1; P=0.009), left atrial appendage length (RR 1.6, 95% CI 1.05–2.5; P=0.03), and appendage width (RR 2.4, 95% CI 1.2–4.81; P=0.01).
In multivariate analysis, independent risk factors for stroke or embolism were hypertension (RR 3.6, 95% CI 1.8–8.4; P=0.001), prior stroke (RR 3.7, 95% CI 1.5–7.5; P=0.002), and older age (RR 1.1, 95% CI 1.0–1.11; P<0.001).
The association between thrombi and stroke or embolism was attenuated after multivariate adjustment (RR 2.4, 95% CI 0.9–6.9; P=0.09).

Structured PICO

Does transesophageal echocardiography assessment of embolic risk predict stroke or embolism better than clinical history in outpatients with nonrheumatic atrial fibrillation?

Population

409 outpatients with nonrheumatic atrial fibrillation and without recent stroke.

Intervention

Transesophageal echocardiography to assess left atrium and left atrial appendage characteristics (thrombi, spontaneous echocardiographic contrast, dimensions). Patients with thrombi received anticoagulation, and patients without thrombi received aspirin.

Outcome

Stroke or embolismhard clinical

Clinical history (age, hypertension, previous stroke) is more useful than transesophageal echocardiography for assessing embolic risk in outpatients with nonrheumatic atrial fibrillation.

Cite This Study

Claudia Stöllberger (1998) studied this question.

synapsesocial.com/papers/6a8232407a56cf6465ffb04e https://doi.org/10.7326/0003-4819-128-8-199804150-00004

Topics

Echocardiography Atrial fibrillation Persistent AF management Anticoagulation in AF

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Implication

Clinical factors may outperform TEE for embolic risk stratification in nonrheumatic AF; hypothesis-generating and should not yet change practice.

Transesophageal Echocardiography To Assess Embolic Risk in Patients with Atrial Fibrillation

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Transesophageal Echocardiography To Assess Embolic Risk in Patients with Atrial Fibrillation

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider