BACKGROUND Covert paroxysmal atrial fibrillation (CPAF) is a major cause of embolic stroke of undetermined source (ESUS). However, detecting PAF during hospitalization in these patients is difficult. OBJECTIVES This study aimed to determine whether findings of transesophageal echocardiography (TEE) during hospitalization are associated with later detection of PAF in patients with ESUS. METHOD We retrospectively studied 348 patients with ESUS who were admitted to our hospital within 1 week of onset. These patients met the criteria of ESUS, underwent TEE during hospitalization, and were followed up for at least 1 year. RESULTS We found PAF in 35 (10.0%) patients. In patients with PAF, spontaneous echo contrast (SEC) and low left atrial appendage flow (LAAF) by TEE and enlargement of the left atrial dimension (LAD) by transthoracic echocardiography were identified more frequently compared with those who did not have PAF. In multivariate analysis, SEC and an LAD ≥42 mm were independently associated with later detection of PAF (p < 0.05). An association of LAAF <46.9 cm/s and PAF was marginal (p = 0.09). The specificity of the combined finding of SEC and/or LAAF with that of LAD increased up to 90%, while that of LAD alone was 70%. CONCLUSIONS The findings of TEE during hospitalization may be useful for identifying patients at increased risk of CPAF in patients with ESUS.

中文翻译：

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经食道超声心动图预测来源不确定的栓塞性卒中患者隐性阵发性心房颤动的有用性。

背景技术隐性阵发性房颤（CPAF）是未确定来源（ESUS）栓塞性中风的主要原因。然而，在这些患者的住院期间检测PAF是困难的。目的本研究旨在确定住院期间经食道超声心动图（TEE）的发现是否与ESUS患者后来发现PAF有关。方法我们回顾性分析了348例在发病1周内入院的ESUS患者。这些患者符合ESUS标准，在住院期间接受了TEE，并随访了至少1年。结果我们在35名（10.0％）患者中发现了PAF。在患有PAF的患者中，与没有PAF的患者相比，经TEE的自发性回声对比（SEC）和左心耳低血流（LAAF）以及经胸超声心动图检查发现左心室扩大（LAD）的频率更高。在多变量分析中，SEC和LAD≥42mm与后来检测到的PAF独立相关（p <0.05）。LAAF <46.9 cm / s与PAF的相关性很小（p = 0.09）。SEC和/或LAAF与LAD联合发现的特异性提高了90％，而单独LAD则为70％。结论住院期间TEE的发现可能有助于确定ESUS患者CPAF风险增加的患者。SEC和LAD≥42mm分别与后来发现PAF有关（p <0.05）。LAAF <46.9 cm / s与PAF的相关性很小（p = 0.09）。SEC和/或LAAF与LAD联合发现的特异性提高了90％，而单独LAD则为70％。结论住院期间TEE的发现可能有助于确定ESUS患者CPAF风险增加的患者。SEC和LAD≥42mm分别与后来发现PAF有关（p <0.05）。LAAF <46.9 cm / s与PAF的相关性很小（p = 0.09）。SEC和/或LAAF与LAD联合发现的特异性提高了90％，而单独LAD则为70％。结论住院期间TEE的发现可能有助于确定ESUS患者CPAF风险增加的患者。