Feasibility of TEE-guided stroke risk assessment in atrial fibrillation—background, aims, design and baseline data of the TIARA pilot studyReportar como inadecuado

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Netherlands Heart Journal

, Volume 19, Issue 5, pp 214–222

First Online: 23 March 2011DOI: 10.1007-s12471-011-0095-3

Cite this article as: Dinh, T., Baur, L.H.B., Pisters, R. et al. Neth Heart J 2011 19: 214. doi:10.1007-s12471-011-0095-3


BackgroundAntithrombotic management in atrial fibrillation AF is currently based on clinical characteristics, despite evidence of potential fine-tuning with transoesophageal echocardiography TEE. This open, randomised, multicentre study addresses the hypothesis that a comprehensive strategy of TEE-based aspirin treatment in AF patients is feasible and safe.

MethodsBetween 2005 and 2009, ten large hospitals in the Netherlands enrolled AF patients with a moderate risk of stroke. Patients without thrombogenic TEE characteristics were randomised to aspirin or vitamin K antagonists VKA. The primary objective is to show that TEE-based aspirin treatment is safe compared with VKA therapy. The secondary objective tests feasibility of TEE as a tool to detect echocardiographic features of high stroke risk. This report compares randomised to non-randomised patients and describes the feasibility of a TEE-based approach.

ResultsIn total, 310 patients were included. Sixty-nine patients were not randomised because of non-visualisation n = 6 or TEE risk factors n = 63. Compared with non-randomised patients, randomised patients n = 241 were younger 65 ± 11 vs. 69 ± 9 years, p = 0.004, had less coronary artery disease 9 vs. 20%, p = 0.018, previous TIA 1.7 vs. 7.2%, p = 0.029, AF during TEE 25 vs. 54%, p < 0.001, mitral incompetence 55 vs. 70%, p = 0.038, VKA use 69 vs. 82%, p = 0.032, had a lower mean CHADS2 score 1.2 ± 0.6 vs. 1.6 ± 1.0, p = 0.004, and left ventricular ejection fraction 59 ± 8 vs. 56 ± 8%, p = 0.016.

ConclusionsThis study shows that a TEE-based approach for fine-tuning stroke risk in AF patients with a moderate risk for stroke is feasible. Follow-up data will address the safety of this TEE-based approach.

KeywordsAtrial fibrillation Stroke risk Antithrombotic treatment The participants in the TIARA pilot study are listed in the Appendix

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Autor: T. Dinh - L. H. B. Baur - R. Pisters - O. Kamp - F. W. A. Verheugt - J. L. R. M. Smeets - E. C. Cheriex - R. G. T

Fuente: https://link.springer.com/

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