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
- 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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