TRANSESOPHAGEAL ECHOCARDIOGRAPHIC DETERMINANTS OF EMBOLISM IN NONRHEUMATIC ATRIAL-FIBRILLATION

The purpose of the study was to determine the relation of transesophag eal echocardiographic findings to symptoms of systemic embolism in pat ients with nonrheumatic atrial fibrillation. Transthoracic and transes ophageal echocardiography were used to study 107 patients with atrial fibrillation including 49 patients without embolic complications and 5 8 patients who had suffered from previous cerebral or peripheral embol ism. A multiple logistic regression analysis revealed that left atrial thrombi (odds ratio 9.0, 95% CI 2.4-33.6, p < 0.005) and the presence of dense left atrial spontaneous contrast (odds ratio 8.4, 95% CI 1.3 -53.1, p < 0.05) were independently related to embolic symptoms. Inten sive left atrial spontaneous contrast was associated with an increased left atrial diameter (odds ratio 2.0, 95% CI 1.1-3.6, p < 0.05), the presence of chronic atrial fibrillation (odds ratio 6.9, 95% CI 1.6-29 .8, p < 0.01) and aortic atherosclerosis (odds ratio 2.6, 95% CI 1.2-5 .5, p < 0.05). It was further negatively correlated to mitral regurgit ation (odds ratio 0.4, 95% CI 0.2-0.9, p < 0.05). In conclusion, dense spontaneous echo contrast and left atrial thrombi are associated to t hromboembolic complications in patients with nonrheumatic atrial fibri llation. Classifying of spontaneous contrast seems to be useful when e stimating the thromboembolic risk in atrial fibrillation.