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Risk factors for intracardiac thrombus in patients with recent ischaemic cerebrovascular events

¹ Cerebrovascular Program, Departments of Neurology and Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
² UNC Stroke Program, Department of Neurology, University of North Carolina, Chapel Hill, North Carolina, USA

Correspondence to:
Correspondence to:
Dr Stephen M Oppenheimer
101 Wendover Road, Baltimore, MD 21218, USA; soppenh{at}hotmail.com

Background: Intracardiac thrombus is a common cause of cardiogenic cerebral ischaemia. Stroke recurrence is high, but thrombus detection with therapeutic intervention can reduce the risk. Accurate detection requires transoesophageal echocardiography (TOE), which is semi-invasive and costly.

Objective: To identify risk factors for cardiac thrombus, enabling selection of patients for TOE and initiation of measures to prevent the formation of cardiac thrombus.

Methods: 151 consecutive patients with ischaemic stroke or transient ischaemic attacks (mean age 62 years) underwent TOE for intracardiac thrombus detection within one week of a qualifying event.

Results: Intracardiac thrombus was found in 26% of the patients (70% in the left atrial appendage). Multivariate analysis indicated the following clinical correlates: large stroke, odds ratio (OR) = 2.8 (95% confidence interval, 1.2 to 6.4); symptomatic coronary artery disease, OR = 3.0 (1.2 to 7.4); and ECG evidence of ischaemia, OR = 2.8 (1.1 to 7.7). Neither carotid stenosis >70%, nor stroke location correlated with the presence of thrombus.

Conclusions: Clinical factors correlate with and appear to be risk factors for cardiac thrombus in patients with recent cerebral ischaemia. These may be used to select appropriate patients for invasive and costly TOE investigation, irrespective of the presence of significant carotid stenosis (70%) or stroke location.

Abbreviations: OCSP, Oxford Community Stroke Project; TOAST, The Obesity Awareness and Solutions Trust; TOE, transoesophageal echocardiography; TTE, transthoracic echocardiography

Keywords: left atrial thrombus; transoesophageal echocardiography; stroke; transient ischaemic attack

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