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Atrial fibrillation: relation between clinical risk factors and transoesophageal echocardiographic risk factors for thromboembolism
  1. S Illien,
  2. S Maroto-Järvinen,
  3. G von der Recke,
  4. C Hammerstingl,
  5. H Schmidt,
  6. S Kuntz-Hehner,
  7. B Lüderitz,
  8. H Omran
  1. Department of Medicine-Cardiology, University of Bonn, Bonn, Germany
  1. Correspondence to:
    Dr H Omran, Department of Medicine-Cardiology, University of Bonn, Sigmund-Freud-Strasse 25, D-53105 Bonn, Germany;


Objective: To correlate clinical risk factors for thromboembolism with transoesophageal echocardiography (TOE) markers of a thrombogenic milieu.

Design: Clinical risk factors for thromboembolism and TOE markers of a thrombogenic milieu were assessed in consecutive patients with non-rheumatic atrial fibrillation. The following TOE parameters were assessed: presence of spontaneous echo contrast, thrombi, and left atrial appendage blood flow velocities. A history of hypertension, diabetes mellitus, or thromboembolic events, patient age > 65 years, and chronic heart failure were considered to be clinical risk factors for thromboembolism.

Setting: Tertiary cardiac care centre.

Patients: 301 consecutive patients with non-rheumatic atrial fibrillation scheduled for TOE.

Results: 255 patients presented with clinical risk factors. 158 patients had reduced left atrial blood flow velocities, dense spontaneous echo contrast, or both. Logistic regression analysis showed that a reduced left ventricular ejection fraction and age > 65 years were the only independent predictors of a thrombogenic milieu (both p < 0.0001). The probability of having a thrombogenic milieu increased with the number of clinical risk factors present (p < 0.0001). 17.4% of the patients without clinical risk factors had a thrombogenic milieu whereas 41.2% of the patients presenting one or more clinical risk factors had none.

Conclusion: There is a close relation between clinical risk factors and TOE markers of a thrombogenic milieu. In addition, TOE examination allows for the identification of patients with a thrombogenic milieu without clinical risk factors.

  • atrial fibrillation
  • thromboembolism
  • transoesophageal echocardiography
  • thrombogenic milieu
  • AF, atrial fibrillation
  • AFI, Atrial Fibrillation Investigators
  • LAA, left atrial appendage, LVEF, left ventricular ejection fraction
  • SEC, spontaneous echo contrast
  • SPAF, stroke prevention in atrial fibrillation
  • TOE, transoesophageal echocardiography
  • TTE transthoracic echocardiography

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