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Clinical Investigations: CARDIOLOGY |

A Transesophageal Echocardiographic Study on Risk Factors for Stroke in Elderly Patients With Atrial Fibrillation*: A Comparison With Younger Patients

Noriko Shinokawa, MD; Tadakazu Hirai, MD; Shutaro Takashima, MD; Tomoki Kameyama, MD; Keiko Nakagawa, MD; Hidetsugu Asanoi, MD; Hiroshi Inoue, MD
Author and Funding Information

*From The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, Toyama, Japan.

Correspondence to: Hiroshi Inoue, MD, The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, 2630 Sugitani, Toyama 930-0194, Japan; e-mail: thirai@ms.toyama-mpu.ac.jp



Chest. 2001;120(3):840-846. doi:10.1378/chest.120.3.840
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Study objectives: Atrial fibrillation (AF) becomes an increasingly important cause of stroke as patients get older. The aim of the study was to determine whether risk factors of cerebral embolism among elderly patients with AF differed from those of younger patients by using transesophageal echocardiography (TEE).

Design and setting: Cross-sectional study at a university hospital.

Methods: Cardiovascular lesions with the potential for thromboembolism in patients with AF were investigated using TEE. Left atrial spontaneous echocardiographic contrast (SEC), peak flow velocity in the left atrial appendage (LAA-flow), and aortic atherosclerosis of the thoracic aorta were assessed in 67 elderly (≥ 70 years old) and 135 younger (< 70 years old) patients. All patients underwent either brain CT (n = 54) or MRI (n = 148) to assess presence of cerebral infarction.

Results: Cerebral infarction due to embolism was noted in 113 patients with AF. There was a higher prevalence of cerebral embolism in elderly patients when compared with younger patients (78% vs 45%; p < 0.001). Cerebral embolism found in younger patients was associated with high grade of SEC and lower LAA-flow (p < 0.05). In addition to these TEE findings, aortic atherosclerosis was more severe in elderly patients with cerebral embolism than in those without cerebral embolism (p < 0.0001). By multivariate logistic analysis, LAA-flow was an independent predictor of cortical infarction in younger patients, but not in elderly patients, whereas aortic atherosclerosis was a useful marker in predicting embolic risk in elderly patients.

Conclusions: TEE findings indicative of left atrial blood stasis were useful to identify the embolic risk of younger patients with AF, while atherosclerosis of the thoracic aorta appears to be an important marker for cerebral embolism in elderly patients.

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