Frequency and significance of cardiac sources of embolism in the TOAST classification.
BACKGROUND
This study was aimed at determining the frequency and coexistent patterns of high- and medium-risk cardiac sources of embolism (CSE) as defined by the Trial of ORG 10172 in the Acute Stroke Treatment (TOAST) classification system and at investigating how identified CSE contributed to this classification.


METHODS
We analyzed data from 2,482 patients with acute cerebral infarctions who registered in the Yonsei Stroke Registry over a 10-year period. Cardiac sources were divided into high- and medium-risk groups based on the TOAST classification.


RESULTS
Of the 2,482 patients, 1,130 (46%) underwent echocardiographic studies. At least one CSE was detected in 629 patients (25%). Atrial fibrillation was the most common high-risk CSE. Patent foramen ovale, spontaneous echo contrast and congestive heart failure comprised most of the medium-risk CSE. Atrial fibrillation frequently accompanied coexistent CSE (69%) such as spontaneous echo contrast, congestive heart failure, and left atrial/appendage thrombus, while patent foramen ovale was detected in isolation in more than 90% of the patients. Patients with a high-risk CSE were more likely to be diagnosed with cardioembolism (83%) than patients with only a medium-risk CSE (58%).


CONCLUSIONS
Our study elucidated the frequency and various coexistent patterns of CSE in Korean stroke patients as defined by the TOAST classification system. In addition, we have demonstrated a higher correlation between high-risk CSE and cardioembolism than with medium-risk CSE and cardioembolism.
Han
Sang Won
SW
Department of Neurology, Sanggyepaik Hospital, Inje University College of Medicine, Seoul, Korea.
Nam
Hyo Suk
HS
Kim
Seo Hyun
SH
Lee
Jong Yun
JY
Lee
Kyung-Yul
KY
Heo
Ji Hoe
JH
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D004617:Embolism / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications; D006331:Heart Diseases / Q000145:classification / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D006333:Heart Failure / Q000150:complications; D006801:Humans; D007723:Korea / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D009626:Terminology as Topic; D014463:Ultrasonography