Relation of transesophageal echocardiographic findings to subtypes of cerebral infarction in patients with atrial fibrillation

Background: Transesophageal echocardiography (TEE) has been used to identif y the potential risk for cardiogenic embolism in patients with atrial fibri llation (AF). However, ischemic stroke in patients with AF is not always at tributable to embolism, Identification of the risk of embolic versus athero thrombotic stroke should lead to the optimal individualized management of p atients with AF. Hypothesis: The goal of the study was to determine the relation between cor tical infarction and perforating infarction and TEE findings in patients wi th AF. Methods: We investigated the clinical usefulness of TEE in the risk stratif ication of clinical subtyping of the cerebral infarctions which were divide d into two territories of the cortical branch (cortical infarction due to e mbolism) and deep perforators (perforating infarction due to atherothrombos is), Left atrial spontaneous echo contrast, peak now velocity in the left a trial appendage, and generalized atherosclerosis as estimated by the intima -media wall thickness of the thoracic aorta were assessed by TEE in 118 con secutive patients with either paroxysmal (n = 44) or chronic (n = 74) AE Al l patients underwent either bl ai n computed tomography ol magnetic resonan ce imaging. Results: Cortical and performing infarction was found in 39 and 18% of pati ents, respectively Thr gl ade of spontaneous echo contrast was higher in pa tients with than in those without cortical infarction (p < 0.05). In contra st, patients with perforating infarction showed significant increase in the aortic wall thickness when compared with patients without perforating infa rction (p < 0.05). In addition, multivariate logistic analysis revealed tha t spontaneous echo contrast was an independent predictor of cortical infarc tion, while intima-media wall thickness of the aorta, hypertension, and age were useful in predicting the risk of perforating infarction. Conclusions: Transesophageal echocardiography has a potential role in the r isk stratification for cortical and perforating infarction in patients with AF.