title: Distribution of potential cardiac sources of embolism in young and older stroke patients: implications for recurrent vascular events.
abstract: BACKGROUND
  Transesophageal echocardiography (TEE) has improved the diagnostic evaluation of ischemic stroke patients, permitting detection of potential cardiac sources of embolism. The present study aimed to evaluate the distribution of potential cardioembolic sources in young versus older stroke patients and their clinical implication for recurrent vascular events. Two hundred and twenty-eight patients with undetermined ischemic stroke were enrolled in the study.
  
  
  METHODS
  All patients were submitted to transthoracic and to TEE examination. The mean follow-up period was 43 +/- 19 months.
  
  
  RESULTS
  The overall detection of cardiac sources of embolism was significantly higher in younger than in older patients (P = 0.006). Atrial septal abnormalities were more prevalent in the younger than in the older population (P = 0.006), whereas complicated aortic plaques were detected more often in older patients. During the follow-up period of 4-5 years, we identified 40 recurrent stroke episodes or vascular deaths. As expected, there was a significant difference in recurrent vascular events and death of older patients compared to the younger ones (P = 0.025).
  
  
  CONCLUSIONS
  The present study demonstrates that atrial septal abnormalities and aortic atheromas are the most prevalent echocardiographic findings in young and elderly stroke patients, respectively. Complicated aortic atheroma is strictly correlated with recurrent cerebral vascular events or death.
authors.affiliation: Department of Cardiovascular and Respiratory Sciences, I Faculty of Medicine, La Sapienza University, Policlinico Umberto I, Rome, Italy. stefano.decastro@uniroma1.it
authors.forename: Stefano
authors.initials: S
authors.lastname: De Castro
authors.forename: Maurizia
authors.initials: M
authors.lastname: Rasura
authors.forename: Emanuele
authors.initials: E
authors.lastname: Di Angelantonio
authors.forename: Mario
authors.initials: M
authors.lastname: Beccia
authors.forename: Ilaria
authors.initials: I
authors.lastname: Passaseo
authors.forename: Filomena
authors.initials: F
authors.lastname: Di Lisi
authors.forename: Cesare
authors.initials: C
authors.lastname: Fieschi
authors.forename: Natesa
authors.initials: N
authors.lastname: Pandian
authors.forename: Francesco
authors.initials: F
authors.lastname: Fedele
mesh_terms: D000328:Adult; D000367:Age Factors; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality; D017548:Echocardiography, Transesophageal; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D020766:Intracranial Embolism / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D014636:Valsalva Maneuver