Pathophysiologic Correlates of Thromboembolism in Nonvalvular Atrial Fibrillation: II. Dense Spontaneous Echocardiographic Contrast (The Stroke Prevention in Atrial Fibrillation [SPAF-III] Study)

Asinger, Richard W.; Koehler, Jodi; Pearce, Lesly A.; Zabalgoitia, Miguel; Blackshear, Joseph L.; Fenster, Paul E.; Strauß, Richard; Hess, Darla B.; Pennock, Gregory D.; Rothbart, Robert M.; Halperin, Jonathan L.

doi:10.1016/s0894-7317(99)70106-9

Cited by 112 publications

(66 citation statements)

References 39 publications

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“…200,250 Hypertension in patients with AF is associated with reduced LAA flow velocity, SEC, and thrombus formation. 225,251,252 Ventricular diastolic dysfunction might underlie the effect of hypertension on LA dynamics, but this relationship is still speculative. 253,254 Whether control of hypertension lowers the risk for cardioembolic stroke in patients with AF is a vital question, because LV diastolic abnormalities associated with hypertension in the elderly are often multifactorial and difficult to reverse.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with AF, aging is associated with LA enlargement, reduced LAA flow velocity, and SEC, all of which predispose to LA thrombus formation. 225,251,256 Aging is a risk factor for atherosclerosis, and plaques in the aortic arch are associated with stroke independent of AF. 257 Levels of prothrombin activation fragment F1.2, an index of thrombin generation, increase with age in the general population 258 -260 as well as in those with AF, 12,261 suggesting an age-related prothrombotic diathesis.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Fuster¹,

Rydén²,

Cannom³

et al. 2006

Circulation

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589

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Fuster¹,

Rydén²,

Cannom³

et al. 2006

Circulation

Self Cite

1,883

589

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“…11,25 Furthermore, the presence of spontaneous echo contrast, a marker of reduced blood flow velocity or stasis, has been shown to be an independent predictor for thromboembolism. 12,26 In this study, we used 4D flow CMR for the assessment of LA blood flow velocities, which has several potential advantages compared with TEE including full volumetric coverage of the LA, quantification of the complete time-resolved, three-directional velocity field inside the LA, and no need for semi-invasive oesophageal intubation. It should be noted that previous TEE studies focused only on the assessment of LAA velocities, while our study was based on the quantification of flow within the entire LA that limits the comparability of findings from both modalities.…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional left atrial blood flow characteristics in patients with atrial fibrillation assessed by 4D flow CMR

Lee

Markl

et al. 2015

Eur Heart J Cardiovasc Imaging

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AimsTo apply 4D flow cardiac magnetic resonance (CMR) for the volumetric measurement of 3D left atrial (LA) blood flow to evaluate its potential to detect altered LA flow in patients with atrial fibrillation (AF) and to investigate associations of changes in systolic and diastolic LA flow with the current clinical risk score (CHA 2 DS 2 -VASc) used for the assessment of thromboembolic risk in AF. Methods and results4D flow CMR was performed in 40 patients with a history of AF (in sinus rhythm during CMR scan, age ¼ 61 + 11 years), 20 age-appropriate controls (59 + 7 years), and 10 young healthy volunteers (24 + 2 years) to measure in vivo time-resolved 3D LA blood flow. LA velocities were characterized with respect to atrial function and timing by calculating normalized LA flow velocity histograms during ventricular systole, early diastole, mid-late diastole, and the entire cardiac cycle. Mean, median, and peak LA velocity steadily decreased when comparing young volunteers, age-appropriate controls, and AF patients by 10 -44% and 8 -26% for early diastole and the entire cardiac cycle, respectively (P , 0.01 for all comparisons except median velocity for young vs. older volunteers and peak velocity for older volunteers and AF patients). There were moderate but significant inverse relationships between increased CHA 2 DS 2 -VASc score and reduced mean LA velocity (early diastole: r ¼ 20.37, P , 0.001; entire RR-interval: r ¼ 20.33, P ¼ 0.005), median LA velocity (r ¼ 20.33, P ¼ 0.003; r ¼ 20.25, P ¼ 0.017), and peak velocity (r ¼ 20.36, P ¼ 0.001; r ¼ 20.45, P , 0.001). LA flow indices also correlated significantly with age and LA volume (R 2 ¼ 0.44-0.62, P , 0.001), but not with left ventricular ejection fraction. ConclusionLeft atrial 4D flow CMR demonstrated significantly reduced LA blood flow velocities in patients with AF. Further study is needed to determine whether these measures can improve upon the CHA 2 DS 2 -VASc score for stroke risk prediction and enhance individual decisions on anticoagulation in patients with AF.--

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“…Hypertension in patients with AF is associated with reduced left atrial appendage flow velocity, spontaneous echo contrast and thrombus formation. [16][17][18] On the other hand, hypertension per se can also increase the risk of non-cardioembolic strokes due to hyalinization of small vessels, fragility of vessels and lacunar infarct in patients with AF. 5,6 A recent analysis from the Stroke Prevention using an ORal Thrombin Inhibitor in atrial Fibrillation Trial (SPORTIF) has shown that the risk of the systemic thromboembolism and stroke in patients with non-valvular AF increased with the level of systolic blood pressure.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of oral anticoagulation therapy in Chinese patients with concomitant atrial fibrillation and hypertension

Siu

Yue

et al. 2010

J Hum Hypertens

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Limited evidence is available on the safety and efficacy of anticoagulants in non-valvular atrial fibrillation (AF) patients with concomitant hypertension. We investigated the safety and efficacy of 476 consecutive anticoagulated Chinese outpatients with non-valvular AF and hypertension. Occurrence of ischaemic stroke and major bleeding, and international normalized ratio (INR) values during these events were recorded. There was no significant difference in anticoagulation control between patients with or without hypertension. INRspecific incidence rates of the events were calculated, which showed no excessive risk for ischaemic stroke (2.5 vs 1.6% per year, P ¼ 0.22) or major bleeding (3.9 vs 3.2% per year, P ¼ 0.29) in non-valvular AF patients with or without hypertension. In multivariate analysis, congestive heart failure, smoking and high CHADS2 score were independent predictors for ischaemic stroke, whereas use of antiplatelet agents was an independent predictor for bleeding. It can be noted that hypertension was not associated with ischaemic stroke or major bleeding. Hypertensive patients who achieved target blood pressure control (o130/80 mm Hg) had a lower ischaemic stroke (0.9 vs 3.1% per year, P ¼ 0.01), but similar bleeding risk compared with those not achieving target blood pressure. Our findings demonstrate the effects of hypertension on the outcomes of warfarin therapy; further investigation is needed to clarify whether more aggressive antihypertensive therapy could result in better outcomes in hypertensive patients with non-valvular AF.

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Pathophysiologic Correlates of Thromboembolism in Nonvalvular Atrial Fibrillation: II. Dense Spontaneous Echocardiographic Contrast (The Stroke Prevention in Atrial Fibrillation [SPAF-III] Study)

Cited by 112 publications

References 39 publications

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Three-dimensional left atrial blood flow characteristics in patients with atrial fibrillation assessed by 4D flow CMR

Safety and efficacy of oral anticoagulation therapy in Chinese patients with concomitant atrial fibrillation and hypertension

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