@article{2998605,
    title = "Prognostic value of trans-thoracic echocardiography in patients with acute stroke and atrial fibrillation: findings from the RAF study",
    author = "Paciaroni, M. and Agnelli, G. and Falocci, N. and Caso, V. and Becattini, C. and Marcheselli, S. and Rueckert, C. and Pezzini, A. and Poli, L. and Padovani, A. and Csiba, L. and Szabó, L. and Sohn, S.-I. and Tassinari, T. and Abdul-Rahim, A.H. and Michel, P. and Cordier, M. and Vanacker, P. and Remillard, S. and Alberti, A. and Venti, M. and Acciarresi, M. and D’Amore, C. and Mosconi, M.G. and Scoditti, U. and Denti, L. and Orlandi, G. and Chiti, A. and Gialdini, G. and Bovi, P. and Carletti, M. and Rigatelli, A. and Putaala, J. and Tatlisumak, T. and Masotti, L. and Lorenzini, G. and Tassi, R. and Guideri, F. and Martini, G. and Tsivgoulis, G. and Vadikolias, K. and Liantinioti, C. and Corea, F. and Del Sette, M. and Ageno, W. and De Lodovici, M.L. and Bono, G. and Baldi, A. and D’Anna, S. and Sacco, S. and Carolei, A. and Tiseo, C. and Imberti, D. and Zabzuni, D. and Doronin, B. and Volodina, V. and Consoli, D. and Galati, F. and Pieroni, A. and Toni, D. and Monaco, S. and Baronello, M.M. and Barlinn, K. and Pallesen, L.-P. and Kepplinger, J. and Bodechtel, U. and Gerber, J. and Deleu, D. and Melikyan, G. and Ibrahim, F. and Akhtar, N. and Lees, K.R.",
    journal = "Egyptian Journal of Neurology, Psychiatry and Neurosurgery",
    year = "2016",
    volume = "263",
    number = "2",
    pages = "231-237",
    publisher = "Dr. Dietrich Steinkopff Verlag GmbH and Co. KG",
    doi = "10.1007/s00415-015-7957-3",
    keywords = "anticoagulant agent, aged;  anticoagulant therapy;  Article;  atrial fibrillation;  brain ischemia;  cerebrovascular accident;  disease severity;  embolism;  female;  heart atrium enlargement;  heart atrium thrombosis;  high risk patient;  human;  major clinical study;  male;  outcome assessment;  priority journal;  prognostic assessment;  recurrence risk;  stroke patient;  transthoracic echocardiography;  atrial fibrillation;  complication;  diagnostic imaging;  echocardiography;  procedures;  prognosis;  recurrent disease;  risk factor;  secondary prevention;  Stroke, Aged;  Atrial Fibrillation;  Echocardiography;  Female;  Humans;  Male;  Prognosis;  Recurrence;  Risk Factors;  Secondary Prevention;  Stroke",
    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. © 2015, Springer-Verlag Berlin Heidelberg."
}