{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T22:53:26Z","timestamp":1784242406396,"version":"3.55.0"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"22","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,11,16]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">To clarify differences in clinical significance of intracardiac thrombi in nonvalvular atrial fibrillation\u2010associated stroke as identified by transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Using patient data on nonvalvular atrial fibrillation\u2010associated ischemic stroke between 2011 and 2014 from 15 South Korean stroke centers (n=4841) and 18 Japanese centers (n=1192), implementation rates of TEE\/TTE, and detection rates of intracardiac thrombi at each center were correlated. The primary outcome was recurrent ischemic stroke at 1\u00a0year after the onset. A total of 5648 patients (median age, 75\u00a0years; 2650 women) were analyzed. Intracardiac thrombi were detected in 75 patients (1.3%) overall. Thrombi were detected in 7.8% of patients with TEE (either TEE alone or TEE+TTE: n=679) and in 0.6% of those with TTE alone (n=3572). Thrombus detection rates varied between 0% and 14.3% among centers. As TEE implementation rates at each center increased from 0% to 56.7%, thrombus detection rates increased linearly (detection rate [%]=0.11\u00d7TEE rate [%]+1.09 [linear regression],\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01). TTE implementation rates (32.3%\u2013100%) were not associated with thrombus detection rates (\n              <jats:italic>P<\/jats:italic>\n              =0.53). Intracardiac thrombi were associated with risk of recurrent ischemic stroke overall (adjusted hazard ratio [aHR] 2.35, 95% CI, 1.07\u20135.16). Thrombus\u2010associated ischemic stroke risk was high in patients with TEE (aHR, 3.13; 95% CI, 1.17\u20138.35), but not in those with TTE alone (aHR, 0.89; 95% CI, 0.12\u20136.51).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Our data suggest clinical relevance of TEE for accurate detection and risk stratification of intracardiac thrombi in nonvalvular atrial fibrillation\u2010associated stroke.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Registration<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT01581502.\n            <\/jats:p>\n          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Lyeong","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Biostatistics College of Medicine Korea University Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8073-9304","authenticated-orcid":false,"given":"Juneyoung","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Biostatistics College of Medicine Korea University Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sohei","family":"Yoshimura","sequence":"additional","affiliation":[{"name":"Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae\u2010Kwan","family":"Cha","sequence":"additional","affiliation":[{"name":"Department of Neurology Dong\u2010A University Hospital Busan 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