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(Stroke. 2007;38:e79.)
© 2007 American Heart Association, Inc.

Letters to the Editor

Response to Letter by Gill et al

Haga Hospital, The Hague, The Netherlands, The Leiden University Medical Centre, Leiden, The Netherlands

Willem R.P. Agema, MD, PhD; Gert Jan Lammers, MD, PhD; Ernst E. van der Wall, MD, PhD; Ron Wolterbeek; Eduard R. Holman, MD, PhD; Edward L.E.M. Bollen, MD, PhD Jeroen J. Bax, MD, PhD

The Leiden University Medical Centre, Leiden, The Netherlands

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Response:

We are grateful to colleagues Gill et al for their comments. We fully agree that the reported prevalence of left atrial appendage thrombus (38/231, 16%) in our series of patients with previous TIA or stroke is relatively, and surprisingly, high. The patients included are an unselected series of consecutive patients with TIA or stroke, in whom no absolute indication for anticoagulation was found after standardized work-up, 12-lead ECG and cardiac history included. It may be hypothesized that some patients had paroxysmal atrial fibrillation, which may predispose to formation of left atrial appendage thrombus. In addition, patients with spontaneous contrast were not excluded from the series, and the prevalence of left atrial appendage thrombus is higher in these patients.

In addition, left atrial appendage thrombus may be present in more patients with stroke and sinus rhythm than previously reported. Recently, Ling et al reported in 11% of elderly stroke patients (50 years of age) with normal sinus rhythm, left atrial appendage thrombus or spontaneous echocardiographic contrast.¹ Possibly, the use of multiplane TEE probes (as compared with mono- and biplane probes) and modern echocardiographic technology has increased image quality, which may play an additional role in the enhanced detection of left atrial appendage thrombi.

On the other hand the prevalence of patent foramen ovale (PFO) in the current series was relatively low. PFO-prevalence in the general population is reported in about 20%, also depending on diagnostic criteria. It is well agreed that cerebral ischemia is seldom caused by paradoxical embolism . . . [Full Text of this Article]