Left Atrial Enlargement Could Be Detected on Extended Computed Tomography Angiography —Reply

In Reply We agree with Popkirov that left atrial volume is a better marker of incident atrial fibrillation than atrial diameter; however, we did not have these data available at all of the sites participating in the New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial Versus ASA to Prevent Embolism in Embolic Stroke of Undetermined Source (NAVIGATE-ESUS) trial. Recently completed and ongoing studies will help determine if our observation has a clinical role and may provide additional data on left atrial size and function. Once all of these data are available, guidelines committees will likely make recommendations regarding the threshold values of left atrial size (if present) for which anticoagulation therapy appears beneficial for patients with embolic stroke of undetermined source. Such recommendations would have to consider how to extrapolate the clinical trial results, allowing for the many different methods for assessing left size. The clinical use of the proposed, nongated computed tomography protocol is interesting, but should await additional studies to define its sensitivity and specificity compared with echocardiography, particularly for detecting other potential cardioembolic causes of stroke, such as patent foramen ovale and left ventricular thrombus.
Source: JAMA Neurology - Category: Neurology Source Type: research

Related Links:

Abstract Cardiogenic stroke (CS), characteristic causes of which include atrial fibrillation (AF) and right-to-left shunting due to a patent foramen ovale (PFO), has a well-known tendency to be associated with a more extensive ischemic area. This may result in severe neurological damage, and require strict life-long antithrombotic therapy. However, the fact that some patients have problems complying with the requirement for extended oral antithrombotic treatment has motivated the development of alternative approaches for stroke prevention. Heart structures such as the left atrial appendage (LAA) and PFO are potent...
Source: Journal of Cardiology - Category: Cardiology Authors: Tags: J Cardiol Source Type: research
Abstract OBJECTIVE/BACKGROUND: Migraine is associated with ischemic stroke. Women are 3-fold as likely as men to have migraine, and high estrogen states increase the risk of migraine with aura (MWA), venous thromboembolism (VTE), and of stroke. We review the epidemiological and mechanistic evidence of the migraine-stroke relationship and its risk factors, with a focus on women and conditions that exclusively or predominantly affect them.  METHODS: We performed a search of MEDLINE/PubMed database, then a narrative review of the epidemiological evidence of the migraine-stroke relationship as...
Source: Headache - Category: Neurology Authors: Tags: Headache Source Type: research
This study aims to investigate the utility of TTE as part of AIS workup.Methods: We collected data on consecutive patients with AIS who were admitted to our institution between 07/01/2016 and 09/30/2017. Patients were included based on neuroimaging-documented AIS, age>18 and neuroimaging studies. Primary endpoint was the proportion of cases in which TTE yielded relevant finding, defined as Atrial Septa Defect or Patent Foramen Ovale, left atrial enlargement, left ventricular thrombus or ejection fraction of
Source: Frontiers in Neurology - Category: Neurology Source Type: research
AbstractPurpose of reviewCryptogenic stroke describes a subset of ischemic stroke for which no cause can be found despite a structured investigation. There are a number of putative mechanisms of cryptogenic ischemic stroke including a covert structural cardiac lesion, paroxysmal atrial fibrillation, hypercoagulable state or undiagnosed malignancy. Because many of these proposed mechanisms are embolic – and based on studies of thrombus history showing commonalities between thrombus composition between cardioembolic and cryptogenic strokes – the concept of embolic stroke of undetermined source (ESUS) (Hart et al....
Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology Source Type: research
AbstractFew data are available on age-related burden and characteristics of embolic stroke of undetermined source (ESUS) in the real world clinical practice. The aim of our study was to provide information about it. We retrospectively analyzed data of patients consecutively admitted to our Stroke Unit along 1  year (2017, November 1st–2018, October 31st). The etiology of ischemic stroke was defined at hospital discharge; ESUS was considered as a subset of cryptogenic stroke, and defined according to the 2014 international criteria. In the analyzed period, 306 patients, 52.3% females, mean age ±&thi...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
Conclusion An occult preexisting atrial fibrillation may lead to unnecessary percutaneous foramen ovale closure in a significant proportion of patients. A 6-month loop-recorder monitoring may improve the patient oriented decision-making.
Source: Journal of Cardiovascular Medicine - Category: Cardiology Tags: Research articles: Arrhythmias Source Type: research
AbstractPurpose of ReviewThis review will discuss the most frequent sources of cardiac embolism and the role of echocardiography in these different clinical settings, and, in addition, provide suggestions about the choice between transthoracic (TTE) and transesophageal echocardiography (TEE).Recent FindingsStroke is the third leading cause of death in industrial countries, and 15 –40% of all ischemic strokes are due to cardioembolism. TTE and TEE are cornerstones in the detection of cardioembolic sources and provide fundamental information about the embolic risk and most suitable treatment of these patients, improvin...
Source: Current Cardiology Reports - Category: Cardiology Source Type: research
Abstract BACKGROUND: Previous randomized controlled trials (RCT) failed to demonstrate benefits of patent foramen ovale (PFO) closure (PFO-C) over medical therapy (MT) for secondary prevention of cryptogenic ischemic stroke. Three recently published RCTs, however, turned out positive for PFO-C and warrant an updated meta-analysis. METHODS: Data from all available RCTs on PFO-C vs. MT for secondary prevention of cryptogenic ischemic stroke up until October 2017 were abstracted and analyzed in a comprehensive meta-analysis. Clinical efficacy outcomes were recurrent stroke, recurrent TIA, and their combination; ...
Source: Clin Med Res - Category: Research Authors: Tags: Clin Res Cardiol Source Type: research
AbstractBackgroundPrevious randomized controlled trials (RCT) failed to demonstrate benefits of patent foramen ovale (PFO) closure (PFO-C) over medical therapy (MT) for secondary prevention of cryptogenic ischemic stroke. Three recently published RCTs, however, turned out positive for PFO-C and warrant an updated meta-analysis.MethodsData from all available RCTs on PFO-C vs. MT for secondary prevention of cryptogenic ischemic stroke up until October 2017 were abstracted and analyzed in a comprehensive meta-analysis. Clinical efficacy outcomes were recurrent stroke, recurrent TIA, and their combination; safety outcomes were...
Source: Clinical Research in Cardiology - Category: Cardiology Source Type: research
>>>Cardiology MCQs from Cardiophile MD Paperback,  Free Look Inside Cardiovascular causes of stroke Atrial fibrillation / flutter Patent foramen ovale (PFO) with right to left shunt or atrial septal aneurysm Cardiomyopathy Aortic arch atheroma Valvular heart disease with intracardiac thrombi or vegetations Atrial myxoma and fibroelastoma Mural thrombus in myocardial infarction Two recent trials (Gore REDUCE and CLOSE) [1,2] and long term outcome results of RESPECT trial [3] provide clear evidence for PFO closure for stroke prevention in those below 60 years with high risk – PFO. High ris...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: General Cardiology Source Type: blogs
More News: Angiography | Atrial Fibrillation | Brain | Cardiology | Clinical Trials | CT Scan | Heart | Neurology | Patent Foramen Ovale | Stroke | Study | Thrombosis