Etiology and outcome of cardioembolic stroke in young adults in Greece.
BACKGROUND
Cardioembolism is the most frequent cause of ischemic stroke in Greece. However, data regarding this stroke subtype in young adults from Greece and the East Mediterranean area are scarce.


METHODS
We aimed to determine the source of embolism and evaluate outcomes in a sample of young Greek patients with ischemic stroke of cardioembolic etiology. A series of 245 Greek patients with ischemic stroke at an age up to 45 years were selected from a consecutive series of 2820 first-ever stroke patients admitted to our departments during the period January 1998 to December 2008.


RESULTS
Cardioembolism was diagnosed in 45 cases (18.4%). Almost half of the cases (48.9%) were attributed to congenital anomalies of the interatrial septum, including 13 cases of patent foramen ovale (28.9%), 7 cases of atrial septum aneurysm (15.6%), and 1 case with both defects (2.2%). The majority of strokes in our young patient collective were related to medium-risk sources of embolism, while high-risk sources, namely dilated cardiomyopathy, atrial fibrillation and akinetic left ventricular lesions, were found in only 33.3%. The overall probability of 10-year survival was 89.4% (95% confidence interval 79.4-99.4), whereas the probability of a new composite vascular event was 14.3% (95% confidence interval 2.3-26.3) during the same period. The clinical outcome in general was excellent, since the majority of patients (82.2%) showed no significant handicap on follow up.


CONCLUSIONS
As in other western countries, it would seem that atrioseptal abnormalities played an important role as a cause of cardioembolism in this young Greek population, whereas atrial fibrillation and other major cardioembolic sources seem to be of minor relevance as compared to stroke in elderly patients.
Spengos
Konstantinos
K
Department of Neurology, University of Athens School of Medicine, Eginition Hospital, Athens, Greece. Spengos@hol.gr
Vemmos
Konstantinos N
KN
D000293:Adolescent; D000328:Adult; D004452:Echocardiography / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D004617:Embolism / Q000150:complications*; D005260:Female; D006115:Greece; D006331:Heart Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult