Relationship between left atrial spontaneous echo contrast and the features of middle cerebral artery territory in nonvalvular atrial fibrillation

We investigated the relationship between left atrial spontaneous echo contr ast (SEC) and cerebrovascular features in nonvalvular atrial fibrillation ( NVAF). Few reports have been published to compare cardiac and cerebrovascul ar imaging in patients with NVAF. Forty-four patients with NVAF were studie d using transesophageal echocardiography and noninvasive imaging including magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and transcranial color Doppler imaging (TCD) in the middle cerebral artery (MC A) territory. The symptomatic severity was divided into asymptomatic, trans ient ischemic attack (TIA), and stroke. The severity of the MRI findings wa s divided into normal, small, and large infarcts. The severity of the MRA f indings was divided into normal, attenuation, and occlusion. MCA was bilate rally scanned and a side-to-side asymmetry ratio of pulsatility index (PI) was measured. The severity of SEC was divided into normal, SEC, and thrombi . Five patients with other thromboembolic risk or poor results of TCD were excluded. SEC and thrombi were detected in 12 (30%) and in 3 patients (5%), respectively. TIA and stroke were detected in 8 (21%) and in 17 patients ( 44%), respectively. Small and large infarcts were detected in 9 (23%) and i n 18 patients (46%), respectively, on MRI. Attenuation and occlusion were d etected in 14 (36%) and in 8 patients (21%), respectively, on MRA. PI ratio was 1.21 +/- 0.25. SEC severity was highly associated with PI ratio and MR A severity in monovariate analysis (P < 0.005), P < 0.01, respectively). SE C severity was highly associated with PI ratio and MRA severity in stepwise multiple regression analysis (P = 0.0001, r = 0.630, n = 39). In patients with NVAF, left atrial SEC was highly related to attenuation or occlusion o n MRA and imbalance of cerebral blood flow on TCD in the MCA territory.