title: Emerging Risk Factors for Recurrent Vascular Events in Patients With Embolic Stroke of Undetermined Source.
abstract: Underlying embolic causes diagnosed by transesophageal echocardiography could be implicated in mechanisms of embolic stroke of undetermined source. We aimed to explore factors, including underlying embolic causes, related to recurrent vascular events in embolic stroke of undetermined source.
  
  
  
  Patients who fulfilled the diagnostic criteria for embolic stroke of undetermined source and whose potential embolic sources were examined by transesophageal echocardiography were included. Recurrent vascular events, including ischemic stroke, cardiovascular and peripheral artery diseases, and vascular death, were retrospectively analyzed. Cox proportional hazards regression analysis was used to explore factors, including clinical characteristics, embolic causes on transesophageal echocardiography, and the Calcification in the Aortic Arch, Age, Multiple Infarction score (CAM), based on the degree of aortic arch calcification on chest radiograph (0-3 points), age (≥70 years; 1 point), and multiple infarctions on magnetic resonance imaging (multiple infarcts in 1, 2, or ≥3 territories of large intracranial arteries, 1, 2, or 3 points) associated with recurrent vascular events.
  
  
  
  A total of 177 patients (age, 64.1±14.2 years; 127 men) were enrolled. Thirty-one patients had recurrent vascular events (follow-up, 3.5±2.7 years; annualized rate, 5.0% per person-year). Among embolic causes on transesophageal echocardiography, incidence of recurrent vascular events was high in patients with large aortic arch plaques (7.5% per person-year). Diabetes mellitus (hazard ratio, 2.56; 95% confidence interval, 1.23-5.32; P=0.012) and CAM score grade (hazard ratio, 2.29; 95% confidence interval, 1.11-4.72; P=0.026) predicted recurrent vascular events.
  
  
  
  History of diabetes mellitus and the CAM score could be novel risk factors for recurrent vascular events in embolic stroke of undetermined source.
authors.affiliation: From the Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan (Y.U., K.Y., R.T., T.K., K.H., N.K., N.H.); and Department of Neurology, Juntendo University Urayasu Hospital, Tokyo, Japan (T.U.). yuji-u@juntendo.ac.jp.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ueno
authors.affiliation: From the Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan (Y.U., K.Y., R.T., T.K., K.H., N.K., N.H.); and Department of Neurology, Juntendo University Urayasu Hospital, Tokyo, Japan (T.U.).
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yamashiro
authors.affiliation: From the Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan (Y.U., K.Y., R.T., T.K., K.H., N.K., N.H.); and Department of Neurology, Juntendo University Urayasu Hospital, Tokyo, Japan (T.U.).
authors.forename: Ryota
authors.initials: R
authors.lastname: Tanaka
authors.affiliation: From the Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan (Y.U., K.Y., R.T., T.K., K.H., N.K., N.H.); and Department of Neurology, Juntendo University Urayasu Hospital, Tokyo, Japan (T.U.).
authors.forename: Takuma
authors.initials: T
authors.lastname: Kuroki
authors.affiliation: From the Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan (Y.U., K.Y., R.T., T.K., K.H., N.K., N.H.); and Department of Neurology, Juntendo University Urayasu Hospital, Tokyo, Japan (T.U.).
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Hira
authors.affiliation: From the Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan (Y.U., K.Y., R.T., T.K., K.H., N.K., N.H.); and Department of Neurology, Juntendo University Urayasu Hospital, Tokyo, Japan (T.U.).
authors.forename: Naohide
authors.initials: N
authors.lastname: Kurita
authors.affiliation: From the Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan (Y.U., K.Y., R.T., T.K., K.H., N.K., N.H.); and Department of Neurology, Juntendo University Urayasu Hospital, Tokyo, Japan (T.U.).
authors.forename: Takao
authors.initials: T
authors.lastname: Urabe
authors.affiliation: From the Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan (Y.U., K.Y., R.T., T.K., K.H., N.K., N.H.); and Department of Neurology, Juntendo University Urayasu Hospital, Tokyo, Japan (T.U.).
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Hattori
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000453:epidemiology; D002545:Brain Ischemia / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D014652:Vascular Diseases / Q000453:epidemiology* / Q000209:etiology*
keywords: aorta, thoracic; echocardiography, transesophageal; infarction; recurrence; stroke