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Predictors of left atrial thrombus in acute ischemic stroke patients without atrial fibrillation: A single-center cross-sectional study
Cinar, Tufan; Hayiroğlu, Mert İlker; Çiçek, Vedat; Asal, Süha; Atmaca, Murat Mert; Keser, Nurgül; Orhan, Ahmet Lütfullah.
  • Cinar, Tufan; Health Science University. Sultan Abdulhamid Han Training and Research Hospital. Department of Cardiology. Istanbul. TR
  • Hayiroğlu, Mert İlker; Health Science University. Sultan Abdulhamid Han Training and Research Hospital. Department of Cardiology. Istanbul. TR
  • Çiçek, Vedat; Health Science University. Sultan Abdulhamid Han Training and Research Hospital. Department of Cardiology. Istanbul. TR
  • Asal, Süha; Health Science University. Sultan Abdulhamid Han Training and Research Hospital. Department of Cardiology. Istanbul. TR
  • Atmaca, Murat Mert; Health Science University. Sultan Abdulhamid Han Training and Research Hospital. Department of Neurology. Istanbul. TR
  • Keser, Nurgül; Health Science University. Sultan Abdulhamid Han Training and Research Hospital. Department of Cardiology. Istanbul. TR
  • Orhan, Ahmet Lütfullah; Health Science University. Sultan Abdulhamid Han Training and Research Hospital. Department of Cardiology. Istanbul. TR
Rev. Assoc. Med. Bras. (1992) ; 66(10): 1437-1443, Oct. 2020. tab, graf
Article in English | SES-SP, LILACS | ID: biblio-1136138
ABSTRACT
SUMMARY

INTRODUCTION:

The present study aimed to determine independent predictors of left atrial thrombus (LAT) in acute ischemic stroke (AIS) patients without atrial fibrillation (AF) using transesophageal echocardiography (TEE).

METHODS:

In this single-center, retrospective study, we enrolled 149 consecutive AIS patients. All of the patients underwent a TEE examination to detect LAT within 10 days following admission. Multivariate logistic regression analysis was performed to assess independent predictors of LAT.

RESULTS:

Among all cases, 14 patients (9.3%) had a diagnosis of LAT based on the TEE examination. In a multivariate analysis, elevated mean platelet volume (MPV), low left-ventricle ejection fraction (EF), creatinine, and reduced left-atrium appendix (LAA) peak emptying velocity were independent predictors of LAT. The area under the receiver operating characteristic curve analysis for MPV was 0.70 (95%CI 0.57-0.83; p = 0.011). With the optimal cut-off value of 9.45, MPV had a sensitivity of 71.4% and a specificity of 63% to predict LAT.

CONCLUSION:

AIS patients with low ventricle EF and elevated MPV should undergo further TEE examination to verify the possibility of a cardio-embolic source. In addition, this research may provide novel information with respect to the applicability of MPV to predict LAT in such patients without AF.
RESUMO
RESUMO

INTRODUÇÃO:

O presente estudo teve como objetivo determinar indicadores independentes do trombo auricular esquerdo (LAT) em doentes com acidente vascular cerebral isquêmico agudo (AIS) sem fibrilação auricular (AF) utilizando ecocardiografia transesofágica (TEE).

MÉTODOS:

Neste único centro, estudo retrospectivo, inscrevemos 149 pacientes consecutivos com AIS. Todos os pacientes foram submetidos a exame de TEE para detectar LAT no prazo de dez dias após a admissão. A análise de regressão logística multivariada foi realizada para avaliar preditores independentes do final.

RESULTADO:

Entre todos os casos, 14 pacientes (9,3%) tiveram um diagnóstico de exame tardio no TEE. Numa análise multivariada, volume médio de plaquetas (VMP) elevado, fração de ejeção do ventrículo esquerdo baixo (EF), creatinina e uma velocidade de pico de esvaziamento do átrio esquerdo reduzida (LAA) foram indicadores independentes da LAT. A área sob a análise da curva característica de operação do receptor para VMP foi de 0,70 (95% IC 0, 57-0, 83; p=0,011). Com o valor-limite ideal de 9,45, o VMP teve uma sensibilidade de 71,4% e uma especificidade de 63% para prever mais tarde.

CONCLUSÃO:

Os doentes AIS com EF ventricular baixa e VMP elevado devem ser submetidos a um exame de TEE adicional para determinar a possibilidade de origem cardioembólica. Além disso, esta investigação pode fornecer novas informações sobre a aplicabilidade do VMP para prever tardiamente os doentes sem AF.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Atrial Fibrillation / Thrombosis / Brain Ischemia / Atrial Appendage / Stroke Type of study: Etiology study / Observational study / Prevalence study / Prognostic study / Risk factors Limits: Humans Language: English Journal: Rev. Assoc. Med. Bras. (1992) Year: 2020 Type: Article Institution/Affiliation country: Health Science University/TR

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Full text: Available Index: LILACS (Americas) Main subject: Atrial Fibrillation / Thrombosis / Brain Ischemia / Atrial Appendage / Stroke Type of study: Etiology study / Observational study / Prevalence study / Prognostic study / Risk factors Limits: Humans Language: English Journal: Rev. Assoc. Med. Bras. (1992) Year: 2020 Type: Article Institution/Affiliation country: Health Science University/TR