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Cardiovascular diseases are the most common cause of mortality and morbidity in adults worldwide.1 Coronary angiography (CAG) is the gold standard method for evaluating atherosclerotic coronary artery disease (CAD).2 It is conventionally performed via the trans-femoral (TF) route. Recently, however, the trans-radial (TR) route has become the preferred way.3 The TR route offers better procedure comfort, shorter hospitalization […]

Coronary artery disease, left ventricular hypertrophy and diastolic dysfunction are associated with stroke in patients affected by persistent non-valvular atrial fibrillation: a case-control study

Pasquale Palmiero, Maria Maiello, Andrea Passantino
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Published Online: Jul 30th 2018 Heart International 2009;4(1):e2 DOI: https://doi.org/10.4081/hi.2009.e2
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Abstract

Overview

Persistent non-valvular atrial fibrillation
(NVAF) is associated with an increased risk
of cardiovascular events such as stroke, and
its rate is expected to rise because of the
ageing population. The absolute rate of
stroke depends on age and comorbidity. Risk
stratification for stroke in patients with
NVAF derives from populations enrolled in
randomized clinical trials. However, participants
in clinical trials are often not representative
of the general population. Many stroke
risk stratification scores have been used, but
they do not include transthoracic echocardiogram
(TTE), pulsate wave Doppler (PWD)
and tissue Doppler imaging (TDI), simple
and non- invasive diagnostic tools. The role
of TTE, PWD and TDI findings has not been
previously determined. Our study goal was to
determine the association between TTE and
PWD findings and stroke prevalence in a population
of NVAF prone outpatients.
Patients were divided into two groups: P
for stroke prone and F for stroke free. There
were no statistically significant differences between the two groups concerning cardiovascular
risk factors, age (p=0.2), sex
(p=0.2), smoking (p=0.3), diabetes (p=0.1)
and hypercholesterolemia (p=0.2); hypertension
was statistically significant (p<0.001).
There were statistically significant differences
concerning coronary artery disease,
previous acute myocardial infarction (AMI)
(p<0.05) and non- AMI coronaropathy
(p<0.04), a higher rate being in the P group.
Concerning echo-Doppler findings, a higher
statistically significant rate of left ventricular
hypertrophy (LVH) (p<0.05) and left ventricular
diastolic dysfunction (p<0.001) was
found in the P group and dilated left atrium
(p<0.04) in the F group, the difference was
not significant for mitral regurgitation
(p=0.7). Stroke prone NVAF patients have a
higher rate of hypertension, coronary artery
disease, with and without AMI, LVH and left
ventricular diastolic dysfunction, but not left
atrial dilatation. M-B mode echocardiography
and PWD examination help to identify highrisk
stroke patients among NVAF subjects;
therefore, they may help in the selection of
appropriate therapy for each patient.

Keywords

Atrial fibrillation, stroke, hypertension, coronary artery disease, left ventricular hypertrophy, left atrial dilatation, echocardiography.

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Article Information

Correspondence

Pasquale Palmiero, Via Francia 47, 72100 Brindisi, Italy E-mail: pasqualepalmiero@iciscu.org

Acknowledgements

The authors thank the nurse,
Mrs. Grazia Quaranta, for her support in management
of patients enrolled in this study.

Received

2008-01-09T00:00:00

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