Prognostic value of trans-thoracic echocardiography in patients with acute stroke and atrial fibrillation

findings from the RAF study

Maurizio Paciaroni, Giancarlo Agnelli, Nicola Falocci, Valeria Caso, Cecilia Becattini, Simona Marcheselli, Christina Rueckert, Alessandro Pezzini, Loris Poli, Alessandro Padovani, Laszló Csiba, Lilla Szabó, Sung Il Sohn, Tiziana Tassinari, Azmil H. Abdul-Rahim, Patrik Michel, Maria Cordier, Peter Vanacker, Suzette Remillard, Andrea Alberti & 52 others Michele Venti, Monica Acciarresi, Cataldo D’Amore, Maria Giulia Mosconi, Umberto Scoditti, Licia Denti, Giovanni Orlandi, Alberto Chiti, Gino Gialdini, Paolo Bovi, Monica Carletti, Alberto Rigatelli, Jukka Putaala, Turgut Tatlisumak, Luca Masotti, Gianni Lorenzini, Rossana Tassi, Francesca Guideri, Giuseppe Martini, Georgios Tsivgoulis, Kostantinos Vadikolias, Chrissoula Liantinioti, Francesco Corea, Massimo Del Sette, Walter Ageno, Maria Luisa De Lodovici, Giorgio Bono, Antonio Baldi, Sebastiano D’Anna, Simona Sacco, Antonio Carolei, Cindy Tiseo, Davide Imberti, Dorjan Zabzuni, Boris Doronin, Vera Volodina, Domenico Consoli, Franco Galati, Alessio Pieroni, Danilo Toni, Serena Monaco, Mario Maimone Baronello, Kristian Barlinn, Lars Peder Pallesen, Jessica Kepplinger, Ulf Bodechtel, Johannes Gerber, Dirk Deleu, Gayane Melikyan, Faisal Ibrahim, Naveed Akhtar, Kennedy R. Lees

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Anticoagulant therapy is recommended for the secondary prevention of stroke in patients with atrial fibrillation (AF). The identification of patients at high risk for early recurrence, which are potential candidates to prompt anticoagulation, is crucial to justify the risk of bleeding associated with early anticoagulant treatment. The aim of this study was to evaluate in patients with acute ischemic stroke and AF the association between findings at trans-thoracic echocardiography (TTE) and 90 days recurrence. In consecutive patients with acute ischemic stroke and AF, TTE was performed within 7 days from hospital admission. Study outcomes were recurrent ischemic cerebrovascular events (stroke or TIA) and systemic embolism. 854 patients (mean age 76.3 ± 9.5 years) underwent a TTE evaluation; 63 patients (7.4 %) had at least a study outcome event. Left atrial thrombosis was present in 11 patients (1.3 %) among whom 1 had recurrent ischemic event. Left atrial enlargement was present in 548 patients (64.2 %) among whom 51 (9.3 %) had recurrent ischemic events. The recurrence rate in the 197 patients with severe left atrial enlargement was 11.7 %. On multivariate analysis, the presence of atrial enlargement (OR 2.13; 95 % CI 1.06–4.29, p = 0.033) and CHA2DS2-VASc score (OR 1.22; 95 % CI 1.04–1.45, p = 0.018, for each point increase) were correlated with ischemic recurrences. In patients with AF-associated acute stroke, left atrial enlargement is an independent marker of recurrent stroke and systemic embolism. The risk of recurrence is accounted for by severe atrial enlargement. TTE-detected left atrial thrombosis is relatively uncommon.

Original languageEnglish (US)
Pages (from-to)231-237
Number of pages7
JournalJournal of Neurology
Volume263
Issue number2
DOIs
StatePublished - Feb 1 2016

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Atrial Fibrillation
Echocardiography
Thorax
Stroke
Recurrence
Embolism
Anticoagulants
Thrombosis
Outcome Assessment (Health Care)
Secondary Prevention
Multivariate Analysis
Hemorrhage
Therapeutics

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

Cite this

Prognostic value of trans-thoracic echocardiography in patients with acute stroke and atrial fibrillation : findings from the RAF study. / Paciaroni, Maurizio; Agnelli, Giancarlo; Falocci, Nicola; Caso, Valeria; Becattini, Cecilia; Marcheselli, Simona; Rueckert, Christina; Pezzini, Alessandro; Poli, Loris; Padovani, Alessandro; Csiba, Laszló; Szabó, Lilla; Sohn, Sung Il; Tassinari, Tiziana; Abdul-Rahim, Azmil H.; Michel, Patrik; Cordier, Maria; Vanacker, Peter; Remillard, Suzette; Alberti, Andrea; Venti, Michele; Acciarresi, Monica; D’Amore, Cataldo; Mosconi, Maria Giulia; Scoditti, Umberto; Denti, Licia; Orlandi, Giovanni; Chiti, Alberto; Gialdini, Gino; Bovi, Paolo; Carletti, Monica; Rigatelli, Alberto; Putaala, Jukka; Tatlisumak, Turgut; Masotti, Luca; Lorenzini, Gianni; Tassi, Rossana; Guideri, Francesca; Martini, Giuseppe; Tsivgoulis, Georgios; Vadikolias, Kostantinos; Liantinioti, Chrissoula; Corea, Francesco; Del Sette, Massimo; Ageno, Walter; De Lodovici, Maria Luisa; Bono, Giorgio; Baldi, Antonio; D’Anna, Sebastiano; Sacco, Simona; Carolei, Antonio; Tiseo, Cindy; Imberti, Davide; Zabzuni, Dorjan; Doronin, Boris; Volodina, Vera; Consoli, Domenico; Galati, Franco; Pieroni, Alessio; Toni, Danilo; Monaco, Serena; Baronello, Mario Maimone; Barlinn, Kristian; Pallesen, Lars Peder; Kepplinger, Jessica; Bodechtel, Ulf; Gerber, Johannes; Deleu, Dirk; Melikyan, Gayane; Ibrahim, Faisal; Akhtar, Naveed; Lees, Kennedy R.

In: Journal of Neurology, Vol. 263, No. 2, 01.02.2016, p. 231-237.

Research output: Contribution to journalArticle

Paciaroni, M, Agnelli, G, Falocci, N, Caso, V, Becattini, C, Marcheselli, S, Rueckert, C, Pezzini, A, Poli, L, Padovani, A, Csiba, L, Szabó, L, Sohn, SI, Tassinari, T, Abdul-Rahim, AH, Michel, P, Cordier, M, Vanacker, P, Remillard, S, Alberti, A, Venti, M, Acciarresi, M, D’Amore, C, Mosconi, MG, Scoditti, U, Denti, L, Orlandi, G, Chiti, A, Gialdini, G, Bovi, P, Carletti, M, Rigatelli, A, Putaala, J, Tatlisumak, T, Masotti, L, Lorenzini, G, Tassi, R, Guideri, F, Martini, G, Tsivgoulis, G, Vadikolias, K, Liantinioti, C, Corea, F, Del Sette, M, Ageno, W, De Lodovici, ML, Bono, G, Baldi, A, D’Anna, S, Sacco, S, Carolei, A, Tiseo, C, Imberti, D, Zabzuni, D, Doronin, B, Volodina, V, Consoli, D, Galati, F, Pieroni, A, Toni, D, Monaco, S, Baronello, MM, Barlinn, K, Pallesen, LP, Kepplinger, J, Bodechtel, U, Gerber, J, Deleu, D, Melikyan, G, Ibrahim, F, Akhtar, N & Lees, KR 2016, 'Prognostic value of trans-thoracic echocardiography in patients with acute stroke and atrial fibrillation: findings from the RAF study', Journal of Neurology, vol. 263, no. 2, pp. 231-237. https://doi.org/10.1007/s00415-015-7957-3
Paciaroni, Maurizio ; Agnelli, Giancarlo ; Falocci, Nicola ; Caso, Valeria ; Becattini, Cecilia ; Marcheselli, Simona ; Rueckert, Christina ; Pezzini, Alessandro ; Poli, Loris ; Padovani, Alessandro ; Csiba, Laszló ; Szabó, Lilla ; Sohn, Sung Il ; Tassinari, Tiziana ; Abdul-Rahim, Azmil H. ; Michel, Patrik ; Cordier, Maria ; Vanacker, Peter ; Remillard, Suzette ; Alberti, Andrea ; Venti, Michele ; Acciarresi, Monica ; D’Amore, Cataldo ; Mosconi, Maria Giulia ; Scoditti, Umberto ; Denti, Licia ; Orlandi, Giovanni ; Chiti, Alberto ; Gialdini, Gino ; Bovi, Paolo ; Carletti, Monica ; Rigatelli, Alberto ; Putaala, Jukka ; Tatlisumak, Turgut ; Masotti, Luca ; Lorenzini, Gianni ; Tassi, Rossana ; Guideri, Francesca ; Martini, Giuseppe ; Tsivgoulis, Georgios ; Vadikolias, Kostantinos ; Liantinioti, Chrissoula ; Corea, Francesco ; Del Sette, Massimo ; Ageno, Walter ; De Lodovici, Maria Luisa ; Bono, Giorgio ; Baldi, Antonio ; D’Anna, Sebastiano ; Sacco, Simona ; Carolei, Antonio ; Tiseo, Cindy ; Imberti, Davide ; Zabzuni, Dorjan ; Doronin, Boris ; Volodina, Vera ; Consoli, Domenico ; Galati, Franco ; Pieroni, Alessio ; Toni, Danilo ; Monaco, Serena ; Baronello, Mario Maimone ; Barlinn, Kristian ; Pallesen, Lars Peder ; Kepplinger, Jessica ; Bodechtel, Ulf ; Gerber, Johannes ; Deleu, Dirk ; Melikyan, Gayane ; Ibrahim, Faisal ; Akhtar, Naveed ; Lees, Kennedy R. / Prognostic value of trans-thoracic echocardiography in patients with acute stroke and atrial fibrillation : findings from the RAF study. In: Journal of Neurology. 2016 ; Vol. 263, No. 2. pp. 231-237.
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abstract = "Anticoagulant therapy is recommended for the secondary prevention of stroke in patients with atrial fibrillation (AF). The identification of patients at high risk for early recurrence, which are potential candidates to prompt anticoagulation, is crucial to justify the risk of bleeding associated with early anticoagulant treatment. The aim of this study was to evaluate in patients with acute ischemic stroke and AF the association between findings at trans-thoracic echocardiography (TTE) and 90 days recurrence. In consecutive patients with acute ischemic stroke and AF, TTE was performed within 7 days from hospital admission. Study outcomes were recurrent ischemic cerebrovascular events (stroke or TIA) and systemic embolism. 854 patients (mean age 76.3 ± 9.5 years) underwent a TTE evaluation; 63 patients (7.4 {\%}) had at least a study outcome event. Left atrial thrombosis was present in 11 patients (1.3 {\%}) among whom 1 had recurrent ischemic event. Left atrial enlargement was present in 548 patients (64.2 {\%}) among whom 51 (9.3 {\%}) had recurrent ischemic events. The recurrence rate in the 197 patients with severe left atrial enlargement was 11.7 {\%}. On multivariate analysis, the presence of atrial enlargement (OR 2.13; 95 {\%} CI 1.06–4.29, p = 0.033) and CHA2DS2-VASc score (OR 1.22; 95 {\%} CI 1.04–1.45, p = 0.018, for each point increase) were correlated with ischemic recurrences. In patients with AF-associated acute stroke, left atrial enlargement is an independent marker of recurrent stroke and systemic embolism. The risk of recurrence is accounted for by severe atrial enlargement. TTE-detected left atrial thrombosis is relatively uncommon.",
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T1 - Prognostic value of trans-thoracic echocardiography in patients with acute stroke and atrial fibrillation

T2 - findings from the RAF study

AU - Paciaroni, Maurizio

AU - Agnelli, Giancarlo

AU - Falocci, Nicola

AU - Caso, Valeria

AU - Becattini, Cecilia

AU - Marcheselli, Simona

AU - Rueckert, Christina

AU - Pezzini, Alessandro

AU - Poli, Loris

AU - Padovani, Alessandro

AU - Csiba, Laszló

AU - Szabó, Lilla

AU - Sohn, Sung Il

AU - Tassinari, Tiziana

AU - Abdul-Rahim, Azmil H.

AU - Michel, Patrik

AU - Cordier, Maria

AU - Vanacker, Peter

AU - Remillard, Suzette

AU - Alberti, Andrea

AU - Venti, Michele

AU - Acciarresi, Monica

AU - D’Amore, Cataldo

AU - Mosconi, Maria Giulia

AU - Scoditti, Umberto

AU - Denti, Licia

AU - Orlandi, Giovanni

AU - Chiti, Alberto

AU - Gialdini, Gino

AU - Bovi, Paolo

AU - Carletti, Monica

AU - Rigatelli, Alberto

AU - Putaala, Jukka

AU - Tatlisumak, Turgut

AU - Masotti, Luca

AU - Lorenzini, Gianni

AU - Tassi, Rossana

AU - Guideri, Francesca

AU - Martini, Giuseppe

AU - Tsivgoulis, Georgios

AU - Vadikolias, Kostantinos

AU - Liantinioti, Chrissoula

AU - Corea, Francesco

AU - Del Sette, Massimo

AU - Ageno, Walter

AU - De Lodovici, Maria Luisa

AU - Bono, Giorgio

AU - Baldi, Antonio

AU - D’Anna, Sebastiano

AU - Sacco, Simona

AU - Carolei, Antonio

AU - Tiseo, Cindy

AU - Imberti, Davide

AU - Zabzuni, Dorjan

AU - Doronin, Boris

AU - Volodina, Vera

AU - Consoli, Domenico

AU - Galati, Franco

AU - Pieroni, Alessio

AU - Toni, Danilo

AU - Monaco, Serena

AU - Baronello, Mario Maimone

AU - Barlinn, Kristian

AU - Pallesen, Lars Peder

AU - Kepplinger, Jessica

AU - Bodechtel, Ulf

AU - Gerber, Johannes

AU - Deleu, Dirk

AU - Melikyan, Gayane

AU - Ibrahim, Faisal

AU - Akhtar, Naveed

AU - Lees, Kennedy R.

PY - 2016/2/1

Y1 - 2016/2/1

N2 - Anticoagulant therapy is recommended for the secondary prevention of stroke in patients with atrial fibrillation (AF). The identification of patients at high risk for early recurrence, which are potential candidates to prompt anticoagulation, is crucial to justify the risk of bleeding associated with early anticoagulant treatment. The aim of this study was to evaluate in patients with acute ischemic stroke and AF the association between findings at trans-thoracic echocardiography (TTE) and 90 days recurrence. In consecutive patients with acute ischemic stroke and AF, TTE was performed within 7 days from hospital admission. Study outcomes were recurrent ischemic cerebrovascular events (stroke or TIA) and systemic embolism. 854 patients (mean age 76.3 ± 9.5 years) underwent a TTE evaluation; 63 patients (7.4 %) had at least a study outcome event. Left atrial thrombosis was present in 11 patients (1.3 %) among whom 1 had recurrent ischemic event. Left atrial enlargement was present in 548 patients (64.2 %) among whom 51 (9.3 %) had recurrent ischemic events. The recurrence rate in the 197 patients with severe left atrial enlargement was 11.7 %. On multivariate analysis, the presence of atrial enlargement (OR 2.13; 95 % CI 1.06–4.29, p = 0.033) and CHA2DS2-VASc score (OR 1.22; 95 % CI 1.04–1.45, p = 0.018, for each point increase) were correlated with ischemic recurrences. In patients with AF-associated acute stroke, left atrial enlargement is an independent marker of recurrent stroke and systemic embolism. The risk of recurrence is accounted for by severe atrial enlargement. TTE-detected left atrial thrombosis is relatively uncommon.

AB - Anticoagulant therapy is recommended for the secondary prevention of stroke in patients with atrial fibrillation (AF). The identification of patients at high risk for early recurrence, which are potential candidates to prompt anticoagulation, is crucial to justify the risk of bleeding associated with early anticoagulant treatment. The aim of this study was to evaluate in patients with acute ischemic stroke and AF the association between findings at trans-thoracic echocardiography (TTE) and 90 days recurrence. In consecutive patients with acute ischemic stroke and AF, TTE was performed within 7 days from hospital admission. Study outcomes were recurrent ischemic cerebrovascular events (stroke or TIA) and systemic embolism. 854 patients (mean age 76.3 ± 9.5 years) underwent a TTE evaluation; 63 patients (7.4 %) had at least a study outcome event. Left atrial thrombosis was present in 11 patients (1.3 %) among whom 1 had recurrent ischemic event. Left atrial enlargement was present in 548 patients (64.2 %) among whom 51 (9.3 %) had recurrent ischemic events. The recurrence rate in the 197 patients with severe left atrial enlargement was 11.7 %. On multivariate analysis, the presence of atrial enlargement (OR 2.13; 95 % CI 1.06–4.29, p = 0.033) and CHA2DS2-VASc score (OR 1.22; 95 % CI 1.04–1.45, p = 0.018, for each point increase) were correlated with ischemic recurrences. In patients with AF-associated acute stroke, left atrial enlargement is an independent marker of recurrent stroke and systemic embolism. The risk of recurrence is accounted for by severe atrial enlargement. TTE-detected left atrial thrombosis is relatively uncommon.

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