title: Prosthetic Valve Thrombosis in the Acute Phase of the Stroke: Relevance of Detection and Follow-Up.
abstract: BACKGROUND
  Stroke may be the first symptom of prosthetic valve thrombosis (PVT); therefore, rapid diagnosis and therapy are crucial. We aimed to evaluate the prevalence, main predictors, and long-term clinical evolution of patients with PVT in the acute phase of stroke.
  
  
  METHODS
  We studied consecutive acute ischemic stroke patients with prosthetic heart valves who underwent emergent transesophageal echocardiography (TEE) during a 5-year period. Two groups were defined depending on the presence of PVT (PVT or non-PVT groups). Baseline characteristics, TEE findings, and international normalized ratios (INRs) at the stroke event were registered. Follow-up visits and TEE control examinations were performed.
  
  
  RESULTS
  Sixty-seven patients were registered. TEE was performed within the first week in 85% of patients (n = 57). PVT was diagnosed in 41.8% of cases (n = 28). Clinical severity and baseline INR level showed no differences when the PVT and non-PVT groups were compared. The presence of PVT was associated with the mitral valve location as compared with the aortic valve location (75% versus 25%, P = .003), the presence of spontaneous echocontrast (64.3% versus 35.9%, P = .022), and low ejection fraction (66.7% versus 32.7%, P = .019). The PVT group showed a trend toward higher percentage of recurrence (10.7% versus 2.5%, P = .102) in the follow up period (mean follow-up 25 months).
  
  
  CONCLUSIONS
  The detection of PVT in the acute stroke phase was relevant, as the stroke recurrence rate was considerable. Therefore, all patients with prosthetic heart valve should undergo emergent TEE.
authors.affiliation: Stroke Unit and Cerebral Hemodynamics, Vall d'Hebron Hospital, Barcelona, Spain.
authors.forename: Jacint
authors.initials: J
authors.lastname: Sala-Padro
authors.affiliation: Stroke Unit and Cerebral Hemodynamics, Vall d'Hebron Hospital, Barcelona, Spain. Electronic address: jorge_pagola@hotmail.com.
authors.forename: Jorge
authors.initials: J
authors.lastname: Pagola
authors.affiliation: Echocardiography Laboratory, Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Gonzalez-Alujas
authors.affiliation: Stroke Unit and Cerebral Hemodynamics, Vall d'Hebron Hospital, Barcelona, Spain.
authors.forename: Laia
authors.initials: L
authors.lastname: Sero
authors.affiliation: Stroke Unit and Cerebral Hemodynamics, Vall d'Hebron Hospital, Barcelona, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Juega
authors.affiliation: Stroke Unit and Cerebral Hemodynamics, Vall d'Hebron Hospital, Barcelona, Spain.
authors.forename: Noelia
authors.initials: N
authors.lastname: Rodriguez-Villatoro
authors.affiliation: Stroke Unit and Cerebral Hemodynamics, Vall d'Hebron Hospital, Barcelona, Spain.
authors.forename: Sandra
authors.initials: S
authors.lastname: Boned
authors.affiliation: Stroke Unit and Cerebral Hemodynamics, Vall d'Hebron Hospital, Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Rodriguez-Luna
authors.affiliation: Stroke Unit and Cerebral Hemodynamics, Vall d'Hebron Hospital, Barcelona, Spain.
authors.forename: Marian
authors.initials: M
authors.lastname: Muchada
authors.affiliation: Echocardiography Laboratory, Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain.
authors.forename: Ruben
authors.initials: R
authors.lastname: Fernandez-Galera
authors.affiliation: Stroke Unit and Cerebral Hemodynamics, Vall d'Hebron Hospital, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Rubiera
authors.affiliation: Stroke Unit and Cerebral Hemodynamics, Vall d'Hebron Hospital, Barcelona, Spain.
authors.forename: Marc
authors.initials: M
authors.lastname: Ribo
authors.affiliation: Echocardiography Laboratory, Cardiology Department, Vall d'Hebron Hospital, Barcelona, Spain.
authors.forename: Arturo
authors.initials: A
authors.lastname: Evangelista
authors.affiliation: Stroke Unit and Cerebral Hemodynamics, Vall d'Hebron Hospital, Barcelona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Molina
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D016208:Databases, Factual; D017548:Echocardiography, Transesophageal; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D015995:Prevalence; D011379:Prognosis; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D013997:Time Factors
keywords: Ischemic stroke; prognosis; prosthetic valve thrombosis; transesophagic ecocardiography