Prognostic value of trans-thoracic echocardiography in patients with acute stroke and atrial fibrillation: findings from the RAF study


Anticoagulant therapy is recommended for the secondary prevention of stroke in patients with atrial fibrillation (AF). T he identification of patients at high risk for early recurrence, which are potential candidates to prompt anticoagulation, is crucial to justify the risk of bleeding associated with early anticoagulant treatment. The aim of this study was to evaluate in patients with acute ischemic stroke and AF the association between findings at trans-thoracic echocardiography (TTE) and 90 days recurrence. In consecutive patients with acute ischemic stroke and AF, TTE was performed within 7 days from hospital admission. Study outcomes were recurrent ischemic cerebrovascular events (stroke or TIA) and systemic embolism. 854 patients (mean age 76.3 ± 9.5 years) underwent a TTE evaluation; 63 patients (7.4 %) had at least a study outcome event. Left atrial thrombosis was present in 11 patients (1.3 %) among whom 1 had recurrent ischemic event. Left atrial enlargement was present in 548 patients (64.2 %) among whom 51 (9.3 %) had recurrent ischemic events. The recurrence rate in the 197 patients with severe left atrial enlargement was 11.7 %. On multivariate analysis, the presence of atrial enlargement (OR 2.13; 95 % CI 1.06–4.29, p = 0.033) and CHA2DS2-VASc score (OR 1.22; 95 % CI 1.04–1.45, p = 0.018, for each point increase) were correlated with ischemic recurrences. In patients with AF-associated acute stroke, left atrial enlargement is an independent marker of recurrent stroke and systemic embolism. The risk of recurrence is accounted for by severe atrial enlargement. TTE-detected left atrial thrombosis is relatively uncommon.

DOI: 10.1007/s00415-015-7957-3

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@article{Paciaroni2015PrognosticVO, title={Prognostic value of trans-thoracic echocardiography in patients with acute stroke and atrial fibrillation: findings from the RAF study}, author={Maurizio Paciaroni and Giancarlo Agnelli and Nicola Falocci and Valeria Caso and Cecilia Becattini and Simona Marcheselli and Christina M. Rueckert and Alessandro Pezzini and Loris Poli and Alessandro Padovani and L{\'a}szl{\'o} Csiba and Lilla Szab{\'o} and Sung-il Sohn and Tiziana Tassinari and Azmil H. Abdul-Rahim and Patrik Michel and Maria Cordier and Peter Vanacker and Suzette Remillard and Andrea Alberti and Michele Venti and Monica Acciarresi and Cataldo D’Amore and Maria Giulia Mosconi and Umberto Scoditti and Licia Denti and Giovanni Orlandi and Alberto Chiti and G Gialdini and Paolo Bovi and Monica Carletti and Alberto Rigatelli and Jukka Putaala and Turgut Tatlisumak and Luca Masotti and Gianni Lorenzini and Rossana Tassi and Francesca Guideri and Giuseppe Martini and Georgios K Tsivgoulis and Kostantinos Vadikolias and Chrissoula Liantinioti and Francesco Corea and Massimo Del Sette and Walter Ageno and Maria Luisa De Lodovici and Giorgio Giovanni Bono and Antonio Baldi and Sebastiano D’Anna and Simona Sacco and Antonio Carolei and Cindy Tiseo and Davide Imberti and Dorjan Zabzuni and Boris M Doronin and Vera Volodina and Domenico Consoli and Franco Galati and Alessio Pieroni and Danilo Toni and Serena Monaco and Mario Maimone Baronello and Kristian Barlinn and Lars-Peder Pallesen and Jessica Kepplinger and Ulf Bodechtel and Johannes C. Gerber and Dirk T Deleu and Gayane Melikyan and Faisal A. F. Ibrahim and Naveed Akhtar and Kennedy R . Lees}, journal={Journal of Neurology}, year={2015}, volume={263}, pages={231-237} }