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European Heart Journal 1994 15(11):1545-1551;
Copyright © 1994 by the European Society of Cardiology.
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© 1994 The European Society of Cardiology

Transthoracic echo/Doppler in the identification of patients with chronic non-valvular atrial fibrillation at risk for thromboembolic events

G. A. M. POP{dagger},, H. J. MEEDER*, J. R. T. C. ROELANDT*, W. VAN OUDENAARDEN{dagger}, C. BULENS{ddagger}, W. VERWEU{dagger}, C. GUSBERS§, R. VAN DOMBURG* and P. J. KOUDSTAAL*

{dagger}Department of Cardiology, Neurology and Clinical Chemistry, Holy Hospital Vlaardingen The Netherlands
*Department of Cardiology and Neurology, Academic Hospital Dijkzigt-Rotterdam The Netherlands
{ddagger}Department of Neurology, Sint Franciscus Gasthuis Rotterdam The Netherlands
§Department of Neurology, Schieland Hospital Schiedam The Netherlands

Received 17 June 1993; revised 3 June 1994; .

Correspondence. Gheorghe A. M. Pop, MD, Division of Cardiology, Thorax-center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.

Abstract

Left atrial spontaneous echo contrast, detected by transoesophegeal echocardiography in patients with non-valvular atrial fibrillation reflects slow blood flow and is associated with an increased risk of cardio-embolism. The purpose of this study was to find echo/Doppler predictors of left atrial spontaneous echo contrast by transthoracic examination. In a retrospective case control study, 17 patients with chronic non-valvular atrial fibrillation who had suffered a recent cerebral ischaemic event (group A) and 17 patients with chronic non-valvular atrial fibrillation who had not suffered such an event (group B) were studied Both groups were matched for age and sex. All patients underwent standard transthoracic echocardiography with transmitral Doppler as well as transoesophageal echocardiography.

Left atrial spontaneous echo contrast was demonstrated by transoesophegeal echocardiography in nine group A patients and in two group B patients (P=0.028); left atrial spontaneous echo contrast was not detected by transthoracic echocardiography in these patients. All patients with left atrial spontaneous echo contrast (11 patients) had a left atrial size, corrected for base index, exceeding 24 mm and a transmitral time velocity integral<10 cm (sensitivity 100%). Left atrial spontaneous echo contrast was absent in six patients with both characteristics (specificity 74%).

Conclusion: transthoracic echol Doppler aids in the prediction of the presence of left atrial spontaneous echo contrast and the identification of patients with non-valvular atrial fibrillation with increased cardioembolic risk, thus avoiding transoesophageal echocardiography.

Key Words: Spontaneous echo contrast in the left atrium • chronic non-valvular atrial fibrillation • transmitral Doppler


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