Incidence of cerebral microembolization in patients with nonvalvular atrial fibrillation using transcranial Doppler

Abstract

Background and aim Atrial fibrillation (AF)-related stroke represented more than 79% of all strokes of cardiogenic origin. AF is the crucial factor of cardiogenic stroke. AF-related stroke is manifested with severe clinical manifestation, significant disability, high mortality, and easier relapse. The incidence of mortality is twice as high as non-AF-related stroke. The AF type is usually of nonvalvular origin. The current work is aiming to determine the incidence of cerebral microembolization in nonvalvular AF patients. Patients and methods The current study was a prospective study of two groups of individuals: control and nonvalvular asymptomatic AF cardiac condition, hypertension, age, diabetes, sex, and stroke (CHADS) score 2 or more. Patients were collected from the cardiology clinic and department (Al-Azhar University Hospital, New Damietta, Egypt). Patients were submitted to history taking, clinical assessment, echocardiography, and transcranial Doppler ultrasonography, and microembolic signal detection and count. Also, the transcranial Doppler was used to monitor both middle cerebral arteries. Results There was a statistically significant difference between the control and study groups in relation to the number of microembolic signals. Signals of microembolizations were detected in eight cases (all were in the study group). There was a positive correlation between embolic signals and patient age (r=0.424, P=0.020) and there was a significant association with female sex. In addition, there was a positive correlation between embolic signals and left-atrium dimension (r=0.502). Regarding correlation, there was a negative interaction between embolic signals and anticoagulation use (r=−0.413, P=0.023). Conclusion Asymptomatic embolic signals occur in patients with nonvalvular AF who are not being treated with anticoagulants at a significantly greater frequency than in age-matched controls.