Distribution of potential cardiac sources of embolism in young and older stroke patients: implications for recurrent vascular events.
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.
De Castro
Stefano
S
Department of Cardiovascular and Respiratory Sciences, I Faculty of Medicine, La Sapienza University, Policlinico Umberto I, Rome, Italy. stefano.decastro@uniroma1.it
Rasura
Maurizia
M
Di Angelantonio
Emanuele
E
Beccia
Mario
M
Passaseo
Ilaria
I
Di Lisi
Filomena
F
Fieschi
Cesare
C
Pandian
Natesa
N
Fedele
Francesco
F
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