Warren J. Manning, MD; Pamela S. Douglas, MD
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Manning W., Douglas P.; Transesophageal Echocardiography: Useful Tool or Expensive Toy?. Ann Intern Med. 1998;129:749. doi: 10.7326/0003-4819-129-9-199811010-00024
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Published: Ann Intern Med. 1998;129(9):749.
We agree with Dr. Kearon that in the younger patient with atrial fibrillation who lacks clinical risk factors, TEE is unlikely to improve on risk stratification. Our comments on the potential role of TEE were restricted to a population at high clinical risk. The SPAF-III study specifically looked at this population (women >75 years of age or persons with hypertension, thromboembolism, left ventricular dysfunction, or congestive heart failure). In this population, dense spontaneous echocardiographic contrast and complex atherosclerotic plaque in the thoracic aorta were independent predictors of clinical thromboembolism . Patients at high clinical risk for thromboembolism who lacked TEE evidence of both left atrial abnormalities and complex aortic plaque had an embolic rate of only 1.3% while receiving combination therapy. This value is similar to that expected in a population at low clinical risk. We therefore hypothesized that if these data are validated in clinical trials, patients with high clinical risk who lack adverse TEE findings may benefit from treatment with aspirin alone (rather than adjusted-dose warfarin).
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