O.S. Sychov, A.O. Borodai, E.S. Borodai Factors influencing the risk of ischemic stroke in patients with non-valvular atrial fibrillation-flutter

The aim – to evaluate clinical and echocardiographic predictors of ischemic stroke in patients with non-valvular atrial fibrillation and flutter (AF-AFl).

Material and methods. In a prospective observational study with a median follow-up of 36.8 months we examined 293 patients with non-valvular AF-AFl with a mean age 60.5±10.4 years, 81 (27.65 %) patients were females. Mean CHA2DS2-VASc score was 2.25±1.46. All patients underwent clinical examination and transthoracic echocardiography. Transesophageal echocardiography was performed in 263 (89.8 %) patients.

Results. Ischemic stroke (IS) occurred in 32 (10.92 %) cases: non-fatal IS – in 26 (8.87 %) cases, fatal IS – in 6 (2.05 %) cases. Onset of IS was associated with left atrial (LA) volume index ≥ 49 ml/m2 (Р=0,011), left atrial appendage spontaneous echo contrast (SEC) 3–4+ (Р<0.001), interventricular septum thickness (IVS) ≥ 1.7 cm (Р=0.02) and class EHRAm III–IV (Р<0,001). SEIL scale (SEC 3–4 + – 1 point, EHRAm III–IV – 1 point, IVS thickness ≥ 1.7 cm – 1 point, LA index ≥ 49 ml/m2 – 1 point) was an independent predictor of occurrence of IS, relative risk (RR) 2.38 (95 % CI 1.68–3.37), Р<0.001, independent of CHA2DS2-VASc, RR 1.28 (95 % CI 1.0–1.62), Р=0.045. Conclusions. SEIL scale may be used for assessment the risk of ischemic stroke In patients with AF-AFl independent of CHA2DS2-VASc scale.

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