Usefulness of Transesophageal Echocardiography for Predicting Covert Paroxysmal Atrial Fibrillation in Patients with Embolic Stroke of Undetermined Source

Yuichiro Ohya, Masato Osaki, Shigeru Fujimoto, Juro Jinnouchi, Takayuki Matsuki, Satomi Mezuki, Masaya Kumamoto, Makoto Kanazawa, Naoki Tagawa, Tetsuro Ago, Takanari Kitazono, Shuji Arakawa

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)98-106
Number of pages9
JournalCerebrovascular diseases extra
DOIs
Publication statusAccepted/In press - Jan 1 2019

Fingerprint

Transesophageal Echocardiography
Atrial Fibrillation
Stroke
Atrial Appendage
Hospitalization
Echocardiography
Multivariate Analysis

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Usefulness of Transesophageal Echocardiography for Predicting Covert Paroxysmal Atrial Fibrillation in Patients with Embolic Stroke of Undetermined Source. / Ohya, Yuichiro; Osaki, Masato; Fujimoto, Shigeru; Jinnouchi, Juro; Matsuki, Takayuki; Mezuki, Satomi; Kumamoto, Masaya; Kanazawa, Makoto; Tagawa, Naoki; Ago, Tetsuro; Kitazono, Takanari; Arakawa, Shuji.

In: Cerebrovascular diseases extra, 01.01.2019, p. 98-106.

Research output: Contribution to journalArticle

Ohya, Yuichiro ; Osaki, Masato ; Fujimoto, Shigeru ; Jinnouchi, Juro ; Matsuki, Takayuki ; Mezuki, Satomi ; Kumamoto, Masaya ; Kanazawa, Makoto ; Tagawa, Naoki ; Ago, Tetsuro ; Kitazono, Takanari ; Arakawa, Shuji. / Usefulness of Transesophageal Echocardiography for Predicting Covert Paroxysmal Atrial Fibrillation in Patients with Embolic Stroke of Undetermined Source. In: Cerebrovascular diseases extra. 2019 ; pp. 98-106.
@article{583f8a71c77747b2a4580262c68d3ed1,
title = "Usefulness of Transesophageal Echocardiography for Predicting Covert Paroxysmal Atrial Fibrillation in Patients with Embolic Stroke of Undetermined Source",
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.",
author = "Yuichiro Ohya and Masato Osaki and Shigeru Fujimoto and Juro Jinnouchi and Takayuki Matsuki and Satomi Mezuki and Masaya Kumamoto and Makoto Kanazawa and Naoki Tagawa and Tetsuro Ago and Takanari Kitazono and Shuji Arakawa",
year = "2019",
month = "1",
day = "1",
doi = "10.1159/000502713",
language = "English",
pages = "98--106",
journal = "Cerebrovascular Diseases Extra",
issn = "1664-5456",
publisher = "S. Karger AG",

}

TY - JOUR

T1 - Usefulness of Transesophageal Echocardiography for Predicting Covert Paroxysmal Atrial Fibrillation in Patients with Embolic Stroke of Undetermined Source

AU - Ohya, Yuichiro

AU - Osaki, Masato

AU - Fujimoto, Shigeru

AU - Jinnouchi, Juro

AU - Matsuki, Takayuki

AU - Mezuki, Satomi

AU - Kumamoto, Masaya

AU - Kanazawa, Makoto

AU - Tagawa, Naoki

AU - Ago, Tetsuro

AU - Kitazono, Takanari

AU - Arakawa, Shuji

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85072766315&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85072766315&partnerID=8YFLogxK

U2 - 10.1159/000502713

DO - 10.1159/000502713

M3 - Article

C2 - 31542780

AN - SCOPUS:85072766315

SP - 98

EP - 106

JO - Cerebrovascular Diseases Extra

JF - Cerebrovascular Diseases Extra

SN - 1664-5456

ER -