Effect of Mitral Regurgitation on Cerebrovascular Accidents in Patients with Atrial Fibrillation and Left Atrial Thrombus

• Published in: Clinical cardiology (Mahwah, N.J.) Vol. 32; no. 11; pp. E7 - E10
• Main Authors: Nair, Chandra K., Aronow, Wilbert S., Shen, Xuedong, Anand, Kishlay, Holmberg, Mark J., Esterbrooks, Dennis J
• Format: Journal Article
• Language: English
• Published: New York Wiley Periodicals, Inc 01.11.2009
• Subjects: Adult; Aged; Aged, 80 and over; atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - diagnostic imaging; Atrial Fibrillation - mortality; Atrial Fibrillation - physiopathology; cerebrovascular accidents; Clinical Investigation; Clinical Investigations; Echocardiography, Doppler, Color; Echocardiography, Doppler, Pulsed; Echocardiography, Transesophageal; Female; Heart Atria - diagnostic imaging; Humans; Incidence; Kaplan-Meier Estimate; left atrial thrombus; Male; Middle Aged; mitral regurgitation; Mitral Valve Insufficiency - complications; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - mortality; Mitral Valve Insufficiency - physiopathology; Prevalence; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Stroke - etiology; Stroke - mortality; Stroke - physiopathology; Stroke Volume; Thrombosis - diagnostic imaging; Thrombosis - etiology; Thrombosis - mortality; Thrombosis - physiopathology; Time Factors; transesophageal echocardiography; Ventricular Function, Left
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.20433

Background The effect of mitral regurgitation (MR) on the incidence of new cerebrovascular accidents (CVA) and mortality in patients with atrial fibrillation (AF) and left atrial thrombus (LAT) is unknown. Objective To investigate the effect of MR in patients with AF and LAT on new CVA and mortality. Methods Eighty nine consecutive patients, mean age 71 years, with AF and LAT documented by transesophageal echocardiography were investigated to determine the prevalence and severity of MR and the association of the severity of MR with new cerebrovascular accidents (CVA) and mortality at 34‐mo follow‐up. Results Of 89 patients, 1 + MR was present in 23 patients (26%), 2 + MR in 44 patients (50%), 3 + MR in 17 patients (19%), and 4 + MR in 3 patients (4%). Mean follow‐up was 34 ± 28 mo. The Cox proportional hazards model showed that the severity of increased MR did not significantly increase new CVA or mortality at 34‐mo follow‐up. The only variable predictive of mortality was left ventricular ejection fraction (LVEF), and with every unit increase in LVEF, the risk decreased by 3%. Conclusion MR occurred in 87 of 89 patients (98%) with AF and LAT. There was no association between the severity of MR and the incidence of CVA or mortality. Copyright © 2009 Wiley Periodicals, Inc.