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Patients With Atrial Fibrillation and Dense Spontaneous Echo Contrast at High Risk A Prospective and Serial Follow-Up Over 12 Months With Transesophageal Echocardiography and Cerebral Magnetic Resonance Imaging Peter Bernhardt, MD*,*, Harald Schmidt, MD , Christoph Hammerstingl, MD*, Berndt Lüderitz, MD, PhD, FACC, FESC, FAHA* and Heyder Omran, MD, PhD * Department of Medicine—Cardiology, University of Bonn, Bonn, Germany St. Marien Hospital Bonn, Bonn, Germany Manuscript received May 16, 2004; revised manuscript received November 3, 2004, accepted November 11, 2004. * Reprint requests and correspondence: Dr. Peter Bernhardt, MRT Center at the Sankt Gertrauden Hospital, Paretzer Str. 12, 10713 Berlin, Germany. (Email: bernhardt@cardiomrt.de ). OBJECTIVES: We sought to assess the prognosis of patients with atrial fibrillation (AF) and dense spontaneous echo contrast (SEC) and to determine the incidence of cerebral embolism under continued oral anticoagulation. BACKGROUND: Patients with AF and dense SEC have an increased risk of cerebral embolism. However, there is little knowledge about the long-term fate and the rate of clinical silent cerebral embolism under continued oral anticoagulation. METHODS: Between 1998 and 2001, all consecutive patients with AF and dense SEC were included in the study. We performed serial and prospective transesophageal echocardiography, cranial magnetic resonance imaging, and clinical examinations during a period of 12 months. RESULTS: A total of 128 patients with dense SEC and AF were included. The control group consisted of 143 patients with faint SEC and AF. During the follow-up period, three patients (2%) had cerebral embolism with neurologic deficits. A total of eight patients (6%) died due to embolic events, and 19 (15%) patients had silent embolism, as documented on cerebral magnetic resonance imaging. Patients with an event had significantly lower left atrial appendage peak emptying velocities and more commonly had a h