Abstract 12807: Characteristics of Patients With Left Atrial Thrombi/spontaneous Echocardiographic Contrast in the Acute Phase After Cardiogenic Cerebral Infarction
Background: Some patients have been reported to have a re-infarction in the acute phase after the onset of cardiogenic cerebral infarction (CI) due to remaining or newly formed left atrial thrombus (LAT). Those patients need strict and rapid treatment with anticoagulants. However, identification of cardiogenic CI patients at risk for re-infarction still remains unclear. We investigated the risk stratification in patients with LAT after the onset of CI.
Methods: We retrospectively studied 97 consecutive patients (55 men, age 69±15) who had suffered acute cardiogenic CI. Neurological score (NIHSS score) and clinical factors were evaluated on admission. A standard 12-lead ECG, transthoracic echocardiography (TTE), transesophageal echocardiography (TEE) and a blood sample for brain natriuretic peptide (BNP) were obtained within 24 hours after the onset of cardiogenic CI. Left atrial thrombi (LAT) and spontaneous echocardiography contrast (SEC) were assessed using TEE.
Results: Fifteen LAT (15%) and 28 SEC (21%) were detected in 97 patients using TEE. All LAT were found in the left atrial appendage. Sixty patients showed atrial fibrillation (AF) in on admission. Patients with LAT/SEC (n = 29) had a higher prevalence of left ventricular hypertrophy (LVH, 52% vs. 13%, P <0.0001), higher NIHSS score (11.3 ± 7.7 vs. 5.9 ± 7.7, P = 0.0021), higher rate of hypertension (72% vs. 47%, P = 0.0217), higher prevalence of persistent AF (89% vs. 47%, P=0.0217), larger left atrial diameter (47 ± 9 mm vs. 39 ± 7 mm, P <0.0001), and higher hemoglobin levels (13.4 ± 2.3 g/dl vs. 12.4 ± 2.3 g/dl, P = 0.0402) compared with patients without LAT/SEC, while BNP levels were not significantly associated. On multivariate analysis, only LVH (P = 0.0241, OR 5.779, 95%CI 1.249-33.236) was independently associated with LAT/SEC.
Conclusion: Detection of left ventricular hypertrophy in the acute phase of patients with cardiogenic cerebral infarction may provide additional risk stratification for re-infarction.
Author Disclosures: H. Kishima: None. T. Mine: None. S. Takahashi: None. K. Ashida: None. M. Ishihara: None. T. Masuyama: None.
- © 2016 by American Heart Association, Inc.