Clinical and transesophageal echocardiographic variables for prediction of thromboembolic events in patients with nonvalvular atrial fibrillation at low-intermediate risk

BackgroundThere is no clear consensus about antithrombotic treatment in atrial fibrillation (AF) patients at low-intermediate thromboembolic risk. Transesophageal echocardiography (TEE) is useful for prediction of thromboembolic events in AF.Methods and resultsOf 498 patients with nonvalvular AF, incidence of stroke, cardiac events, and mortality was investigated in 280 patients with CHADS2 score 0 or 1 (mean age 64 years, mean follow-up 6.4 ± 3.1 years). Left atrial abnormality (low left atrial appendage flow, spontaneous echo contrast, or thrombi), complex aortic plaque (mobile, ulcerated, pedunculate, or thickness ≥ 4 mm), or both were defined as TEE risk. The incidences of ischemic stroke, cardiovascular events, and death were higher in patients with TEE risk than in those without the risk (2.0%/year vs. 0.5%/year, p < 0.05; 4.7%/year vs. 1.9%/year, p < 0.01; and 4.7%/year vs. 2.0%/year, p < 0.01, respectively). This was also true for patients with CHADS2 score of 0 (1.7%/year vs. 0.3%/year, p < 0.05; 4.1%/year vs. 1.6%/year, p < 0.05; and 3.9%/year vs. 1.4%/year, p < 0.01; respectively). On multivariate analysis, TEE risk predicted ischemic stroke, cardiovascular events, and mortality independently of clinical variables or CHADS2 score.ConclusionsTEE could be useful for further stratification of patients with nonvalvular AF stratified at low-intermediate risk (CHADS2 score 0 or 1) and could indicate who should receive anticoagulation treatment.