title: Impact of valvular thickness on stroke recurrence in medically treated patients with stroke.
abstract: BACKGROUND
  It remains controversial whether left-sided valvular thickening (VaT) is a risk factor for ischemic stroke. Little is known about the relationship between VaT and the recurrent adverse event rate in medically treated patients with stroke.
  
  
  METHODS
  We examined the outcomes of 627 noncardioembolic stroke patients who were double-blindly assigned to either warfarin or aspirin therapy and assessed VaT using transesophageal echocardiography. Endpoints were recurrent ischemic stroke or death from any cause. The Cox proportional hazards model was used to adjust for covariates.
  
  
  RESULTS
  VaT was present in 57.3% of the patients (359/627), 34.6% (271/627) involving the aortic valve and 46.4% (291/627) involving the mitral valve. There was no difference in the time to primary endpoints between those with and without VaT of the aortic valve (p = 0.49; hazard ratio, HR: 1.17; 95% CI: 0.74-1.85; 2-year event rates: 18.9 vs. 13.2%) or mitral valve (p = 0.66; HR: 0.91; 95% CI: 0.60-1.38; 2-year event rates: 16.9 vs. 14.7%). Among the patients with VaT, there was no significant difference in the time to primary endpoints between those treated with warfarin and those with aspirin (p = 0.13, HR: 0.65, 95% CI: 0.37-1.14, 2-year event rates: 15.2 vs. 22.7% for the aortic valve; p = 0.22, HR: 0.70, 95% CI: 0.40-1.23, 2-year event rates: 14.2 vs. 19.6% for the mitral valve).
  
  
  CONCLUSIONS
  VaT does not appear to increase recurrent adverse event rates in medically treated patients with ischemic stroke, regardless of warfarin or aspirin therapy.
authors.affiliation: Department of Medicine, Columbia University, New York, NY 10032, USA. OkajimaKazue@aol.com
authors.forename: K
authors.initials: K
authors.lastname: Okajima
authors.forename: Y
authors.initials: Y
authors.lastname: Abe
authors.forename: K
authors.initials: K
authors.lastname: Suzuki
authors.forename: M J
authors.initials: MJ
authors.lastname: Salameh
authors.forename: M R
authors.initials: MR
authors.lastname: Di Tullio
authors.forename: Z
authors.initials: Z
authors.lastname: Jin
authors.forename: R L
authors.initials: RL
authors.lastname: Sacco
authors.forename: J P
authors.initials: JP
authors.lastname: Mohr
authors.forename: S
authors.initials: S
authors.lastname: Homma
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology*; D001241:Aspirin / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D004311:Double-Blind Method; D017548:Echocardiography, Transesophageal; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000473:pathology*; D016016:Proportional Hazards Models; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality / Q000473:pathology*; D013997:Time Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use*