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Titolo:
ECHOCARDIOGRAPHIC PREDICTORS OF STROKE IN PATIENTS WITH ATRIAL-FIBRILLATION - A PROSPECTIVE-STUDY OF 1066 PATIENTS FROM 3 CLINICAL-TRIALS
Autore:
EZEKOWITZ M; LAUPACIS A; BOYSEN G; CONNOLLY S; HART R; JAMES K; KISTLER P; KOUDSTAAL P; KRONMAL R; MCBRIDE R; PETERSEN P; SINGER D;
Indirizzi:
YALE UNIV,333 CEDAR ST,3 FMP,POB 3333 NEW HAVEN CT 06510
Titolo Testata:
Archives of internal medicine
fascicolo: 12, volume: 158, anno: 1998,
pagine: 1316 - 1320
SICI:
0003-9926(1998)158:12<1316:EPOSIP>2.0.ZU;2-U
Fonte:
ISI
Lingua:
ENG
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
8
Recensione:
Indirizzi per estratti:
Citazione:
M. Ezekowitz et al., "ECHOCARDIOGRAPHIC PREDICTORS OF STROKE IN PATIENTS WITH ATRIAL-FIBRILLATION - A PROSPECTIVE-STUDY OF 1066 PATIENTS FROM 3 CLINICAL-TRIALS", Archives of internal medicine, 158(12), 1998, pp. 1316-1320

Abstract

Background: Clinical features that consistently predict ischemic stroke in patients with nonvalvular atrial fibrillation have been identified, while echocardiographic risk factors are less well defined. Objective: To determine whether the results of transthoracic echocardiography add independent information to the clinical risk factors for stroke in patients with atrial fibrillation. Methods: Transthoracic echocardiographic findings and clinical features from 1066 patients with atrialfibrillation assigned to placebo or control in 3 randomized trials (Boston Area Anticoagulation Trial for Atrial Fibrillation, Stroke Prevention in Atrial Fibrillation I Study, and Veterans Affairs Prevention in Atrial. Fibrillation Study) were correlated with subsequent ischemic stroke by multivariate analysis. Results: The mean +/- SD age of patients was 67 +/- 10 years, 78% were men, 55% had a history of hypertension, 19% had a history of diabetes, 7% had a previous transient ischemic attack or stroke, and 27% had a history of heart failure. During amean follow-up of 1.6 years, 78 ischemic strokes occurred (annual rate, 4.7%). Moderate to severe left ventricular systolic dysfunction shown via 2-dimensional echocardiography was a strong independent predictor of stroke (relative risk, 2.5; P<.001) in the 1010 patients in whomechocardiographic values for left ventricular function were available. Left atrial diameter by M-mode echocardiography did not predict stroke (relative risk, 1.02/mm; P =.10). Of 163 patients categorized as low risk based on clinical features (annual stroke rate, 0.8%; 95% confidence interval, 0.2%-3.0%), 10 had moderate to severe left ventriculardysfunction shown via 2-dimensional echocardiography and a 9.3% per year risk of stroke (95% confidence interval, 1.3%-66%). Conversely, 728 of the 847 patients at high risk for stroke based on clinical criteria had normal or mildly abnormal left ventricular function; their stroke rate was 4.4% (95% confidence interval, 3.4%-5.8%). Conclusions: Left ventricular systolic dysfunction shown via 2-dimensional transthoracic echocardiography independently predicts risk of stroke in patientswith atrial fibrillation. Echocardiography may prove most useful in asmall group of patients who have a low risk of stroke according to clinical factors.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 30/11/20 alle ore 16:12:52