Prevalence of silent myocardial ischemia in single and multiple lacunar infarcts and large vessel disease stroke.
OBJECTIVE
The relationships between single (SLI) and multiple lacunar infarcts (MLI) and occult coronary artery disease (CAD) have not yet been sufficiently evaluated. We aimed to investigate the prevalence of silent CAD in patients with SLI, MLI and large vessel disease (LVD) stroke, and to identify factors associated with its presence.


METHODS
We enrolled 125 patients who had suffered their first non-cardioembolic ischemic stroke but had no documented history of CAD. According to their pathologies, these patients were assigned to one of three groups: MLI (n=21), SLI (n=50) or LVD (n=54). Asymptomatic CAD was detected by myocardial perfusion SPECT imaging.


RESULTS
Silent CAD was detected in 40 patients (32% of the total); of those that experienced CAD, 15 (30%) were from the SLI group, 7 (33%) had MLI, and 18 (33%) had an LVD stroke. Differences between the groups were not significant. During a median follow-up of 48 months, the overall stroke recurrence was 8.8%; the stroke recurrence rates for each subgroup were 6% in patients with SLI, 7% in LVD and 19% in MLI. Mortality was higher in patients from the MLI and LVD groups (26% and 14%, respectively) than in those from the SLI group (6%; p=0.02). We found no relationships between the various risk factors and silent CAD.


CONCLUSIONS
In this exploratory study, SPECT imaging results revealed that the prevalence of abnormal myocardial perfusion was similar in patients with either single or multiple lacunar infarcts and those that had experienced large vessel disease stroke.
Stroke Clinic, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico. arauzg@prodigy.net.mx
Antonio
A
Arauz
Juan
J
Calleja
Enrique
E
Vallejo
Lisveth
L
Quintero
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000145:classification / Q000150:complications* / Q000000981:diagnostic imaging; D001808:Blood Vessels / Q000473:pathology; D020520:Brain Infarction / Q000145:classification / Q000150:complications*; D004176:Dipyridamole; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D055414:Myocardial Perfusion Imaging; D009929:Organ Size; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012307:Risk Factors; D020521:Stroke / Q000145:classification* / Q000150:complications / Q000473:pathology; D015899:Tomography, Emission-Computed, Single-Photon
D019275:Radiopharmaceuticals; D004176:Dipyridamole