A transesophageal echocardiographic study on risk factors for stroke in elderly patients with atrial fibrillation - A comparison with younger patients

Study objectives: Atrial fibrillation (AF) becomes an increasingly importan t cause of stroke as patients get older. The aim of the study was to determ ine whether risk factors of cerebral embolism among elderly patients with A F differed from those of younger patients by using transesophageal echocard iography (TEE). Design and setting: Cross-sectional study at a university hospital. Methods: Cardiovascular lesions with the potential for thromboembolism in p atients with AF were investigated using TEE. Left atrial spontaneous echoca rdiographic contrast (SEC), peak flow velocity in the left atrial appendage (LAA-flow), and aortic atherosclerosis of the thoracic aorta were assessed in 67 elderly (greater than or equal to 70 years old) and 135 younger (< 7 0 years old) patients. All patients underwent either brain CT (n = 54) or M RI (n = 148) to assess presence of cerebral infarction. Results: Cerebral infarction due to embolism was noted in 113 patients with AF. There was a higher prevalence of cerebral embolism in elderly patients when compared with younger patients (78% vs 45%; p < 0.001). Cerebral embo lism found in younger patients was associated with high grade of SEC and lo wer LAA-flow (p < 0.05). In addition to these TEE findings, aortic atherosc lerosis was more severe in elderly patients with cerebral embolism than in those without cerebral embolism (p < 0.0001). By multivariate logistic anal ysis, LAA-flow was an independent predictor of cortical infarction in young er patients, but not in elderly patients, whereas aortic atherosclerosis wa s a useful marker in predicting embolic risk in elderly patients. Conclusions: TEE findings indicative of left atrial blood stasis were usefu l to identify the embolic risk of younger patients with AF, while atheroscl erosis of the thoracic aorta appears to be an important marker for cerebral embolism in elderly patients.