Incidence of left atrial thrombi in patients in sinus rhythm and with a recent neurologic deficit

Omran, Heyder; Rang, Barbara; Schmidt, Harald; Illien, Stefan; Schimpf, Rainer; MacCarter, Dean; Kubini, R.; Recke, Giso von der; Tiemann, Klaus; Becher, Harald; Lüderitz, Berndt

doi:10.1067/mhj.2000.109213

Cited by 55 publications

(38 citation statements)

References 24 publications

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“…This frequency is similar to that recently reported 2 but is apparently lower than the frequency in a more selected group of patients with acute neurological events. 3 This low frequency is further supported by the infrequent finding of LA spontaneous echocardiographic contrast in patients with SR. 15 2. Patients in whom LA thrombus is detected in SR are characterized by specific cardiac abnormalities, notably significant left ventricular dysfunction, valve disease (predominantly mitral valve disease), or previous episodes of AF.…”

Section: Discussionsupporting

confidence: 48%

“…LA thrombus is usually detected in association with atrial arrhythmias but is uncommon in the presence of sinus rhythm (SR). 2,3 Thus, the yield of TEE in detecting LA thrombus in unselected patients with SR appears to be low. 4,5 The objectives of our study were to determine the clinical and echocardiographic characteristics of patients with echocardiographically detected LA thrombus who were in SR during the echocardiographic examination.…”

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confidence: 99%

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Clinical and Echocardiographic Characteristics of Patients With Left Atrial Thrombus and Sinus Rhythm

et al. 2002

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Background-Left atrial (LA) thrombus is infrequently detected in the presence of sinus rhythm (SR) and, in these cases, is usually associated with additional cardiac pathologies. We sought to determine the clinical and echocardiographic characteristics of patients with LA thrombus and SR to define a high-risk group of patients prone to this uncommon clinical presentation. Methods and Results-The institution's echocardiographic laboratory database was searched to identify patients with LA thrombus, diagnosed by transesophageal echocardiography (TEE), who were in SR during the TEE examination. Of 20 643 consecutive TEE examinations performed during an 11-year period, LA thrombus was detected in 314 patients in 380 TEE examinations. Of these, SR was present in 20 patients (age 69Ϯ13 years; 40% men) in 23 examinations (0.1% of all TEE examinations; 6.1% of TEE examinations with LA thrombus). High-risk structural heart disease (severe left ventricular dysfunction or significant left-sided valve disease [predominantly mitral valve disease]), previous documented episodes of atrial fibrillation, or both (structural heart disease and previous atrial fibrillation) were present in 10, 4, and 5 of the 20 patients, respectively.

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Section: Discussionsupporting

confidence: 48%

mentioning

confidence: 99%

Clinical and Echocardiographic Characteristics of Patients With Left Atrial Thrombus and Sinus Rhythm

et al. 2002

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“…These results should be questioned given that the rate of LAT in patients in SR is typically 1% to 2%. 37,38 However, the finding of slow LA flow (Յ55 cm/s) or…”

Section: Patient Selection For Cardiac Structural Imagingmentioning

confidence: 99%

“…LAT and SEC are usually seen in patients with AF or significant mitral valve disease, which are often detected by other means and already have an indication for OAC. 37,38 Statins have been shown to be beneficial in complex aortic atheroma, but there is no clear consensus on antiplatelet versus OAC therapy for secondary stroke prevention. 39 The clinical relevance and management of patients related to the detection of a PFO and ASA must be individualized and in most cases do not warrant treatment with OAC.…”

Section: Patient Selection For Cardiac Structural Imagingmentioning

confidence: 99%

Cardiac Workup of Ischemic Stroke

Morris

Duffis

Fisher

2009

Stroke

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Background and Purpose-Discovering potential cardiac sources of stroke is an important part of the urgent evaluation of the ischemic stroke patient as it often impacts treatment decisions that are essential for determining secondary stroke prevention strategies, yet the optimal approach to the cardiac workup of an ischemic stroke patient is not known. Methods-A review of the literature concerning the utility of cardiac rhythm monitoring (ECG, telemetry, Holter monitors, and event recorders) and structural imaging (transthoracic and transesophageal echocardiography) was performed. Results-Data supporting a definitive, optimal, and cost-effective approach are lacking, though some data suggest that appropriate patient selection can improve the diagnostic and therapeutic yield of rhythm monitoring and echocardiography in the evaluation of stroke etiology. Conclusions-Based on available data, an algorithmic approach for the evaluation of patients with acute ischemic cerebrovascular events that takes into account therapeutic and diagnostic yield as well as cost-efficiency is proposed.

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“…Left ventricular mass (LVM) was calculated using the linear method and the following formula: LV mass = 0.8 x 1.04 x [(IVS + LVID + PWT) 3 -LVID 3 ] + 0.6 g. IVS was interventricular septum thickness, LVID was LV internal diameter and PWT was inferolateral wall thickness at end-diastole. All measurements were acquired from the parasternal long-axis view, obtained perpendicular to the LV long axis, and measured at the level of the mitral valve leaflet tips.…”

Section: Echocardiographymentioning

confidence: 99%

Prothrombotic State in Patients With a Left Atrial Appendage Thrombus of Unknown Origin and Cerebrovascular Events

Meus

Son

Sobczyk

et al. 2016

Stroke

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Background and Purpose— We hypothesized that formation of left atrial appendage (LAA) thrombi of unknown origin is associated with altered fibrin clot properties and blood hypercoagulability. Methods— In a case–control study, we investigated 32 patients with a history of LAA thrombus after successful anticoagulant treatment versus 32 control subjects matched for age, sex, and diabetes mellitus. All subjects had previous ischemic stroke, transient ischemic attack, or migraine associated with patent foramen ovale. Patients with documented atrial fibrillation were excluded. We determined plasma fibrin clot permeability, fibrinolytic efficiency, thrombin generation, platelet and endothelial markers. Stroke or transient ischemic attack were assessed during a median follow-up of 74 (range 19–98) months. Results— Compared with controls, patients with LAA thrombus more frequently were smokers (43.8% versus 18.8%) and had 20% prolonged clot lysis time, lower plasminogen (−14%), and higher plasminogen activator inhibitor-1 (+17%), thrombin–antithrombin complexes (+17%), CD40 ligand (+30%), P-selectin (+29%), and von Willebrand factor (+30%, all P <0.05). Occurrence of LAA thrombus was predicted by von Willebrand factor (β=0.038, P =0.004), plasminogen (β=−0.048, P =0.01), plasminogen activator inhibitor-1 (β=−0.161, P =0.03), and clot permeability (β=−1.076, P =0.03). During follow-up, cerebrovascular events occurred in 10 (33.33%) of the 30 available patients in the LAA thrombus group, including 7 (23.3%) with recurrent LAA thrombus and 4 (13.33%) with documented atrial fibrillation. Recurrent LAA thrombus was associated with lower baseline K s and higher thrombin generation, fibrinogen, plasminogen activator inhibitor-1, and soluble CD40 ligand (all P <0.05). Conclusions— Prothrombotic blood alterations could be involved in the LAA thrombus formation in patients without documented atrial fibrillation and are associated with increased risk of stroke or transient ischemic attack during follow-up.

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Incidence of left atrial thrombi in patients in sinus rhythm and with a recent neurologic deficit

Cited by 55 publications

References 24 publications

Clinical and Echocardiographic Characteristics of Patients With Left Atrial Thrombus and Sinus Rhythm

Clinical and Echocardiographic Characteristics of Patients With Left Atrial Thrombus and Sinus Rhythm

Cardiac Workup of Ischemic Stroke

Prothrombotic State in Patients With a Left Atrial Appendage Thrombus of Unknown Origin and Cerebrovascular Events

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