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

作者：Dinh T^*; Baur L H B; Pisters R; Kamp O; Verheugt F W A; Smeets J L R M; Cheriex E C; Tieleman R G; Prins M H; Crijns H J G M

来源：Netherlands Heart Journal, 2011, 19(5): 214-222.

DOI：10.1007/s12471-011-0095-3

• Atrial fibrillation
• Stroke risk
• Antithrombotic treatment

Background Antithrombotic 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.
Methods Between 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.
Results In 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 CHADS(2) 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).
Conclusions This 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.

• 出版日期2011-5