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Background: Intracardiac thrombus is a common cause of cardiogenic cerebral is chaemia. Stroke recurrence is high, but thrombus detection with therapeutic inte rvention can reduce the risk. Accurate detection requires transoesophageal echoc ardiography (TOE), which is semi invasive and costly. Objective: To identify ri sk factors for cardiac thrombus, enabling selection of patients for TOEand initi ation of measures to prevent the formation of cardiac thrombus. Methods: 151 con secutive 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 patie nts (70%in the left atrial appendage). Multivariate analysis indicated the foll owing clinical correlates: large stroke, odds ratio (OR) = 2.8 (95%confidence i nterval, 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. Conclusion s: Clinical factors correlate with and appear to be risk factors for cardiac thr ombus in patients with recent cerebral ischaemia. These may be used to select ap propriate patients for invasive and costly TOE investigation, irrespective of th e presence of significant carotid stenosis (≥70%) or stroke location.
Background: Intracardiac thrombus is a common cause of cardiogenic cerebral is chaemia. Stroke recurrence is high, but thrombus detection with therapeutic inte rvention can reduce the risk. Accurate detection requires transoesophageal echoc ardiography (TOE), which is semi-invasive and costly. Objective: To identify ri sk factors for cardiac thrombus, enabling selection of patients for TOE and initiating of measures to prevent the formation of cardiac thrombus. Methods: 151 con secutive patients with ischaemic stroke or transient ischaemic attacks (mean age 62 years) underwent TOE for intracardiac Results: Intracardiac thrombus was found in 26% of the patients (70% in the left atrial appendage). Multivariate analysis indicated the foll due 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. Conclusion s: Clinical factors correlate with and appear to be risk factors for cardiac thr ombus in patients with recent cerebral ischaemia. These may be used to select ap propriate patients for invasive and costly TOE investigation, irrespective of th e presence of significant carotid stenosis (≥70%) or stroke location.