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Low Incidence of Cerebrovascular Events in Patients with Incidental Atrial Septal Aneurysm
Andrew J. Burger1, Praveen Jadhav, Masoor Kamalesh
1Deaconess Hospital, Noninvasive Cardiology Laboratory, Baker-3, 1 Deaconess Road, Boston, MA 02215.
Insights
Atrial septal aneurysm (ASA) characteristics do not predict cerebrovascular events. While ASA may pose an embolic stroke risk, it appears lower than previously estimated.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Atrial septal aneurysm (ASA) is a cardiac anomaly.
- The association between ASA and cerebrovascular events requires further clarification.
Purpose of the Study:
- To describe echocardiographic features of ASA and related cardiac abnormalities.
- To identify echocardiographic predictors of cerebrovascular events in ASA patients.
- To compare cerebrovascular risk in incidental ASA versus ASA with diagnostic indications.
Main Methods:
- Retrospective analysis of 117 patients with ASA identified via transesophageal echocardiography.
- Comparison of ASA characteristics and cerebrovascular event rates between incidental findings (Group I) and patients with diagnostic indications (Group II).
Main Results:
- No significant differences in echocardiographic characteristics or associated abnormalities between groups.
- No intracardiac or ASA-associated thrombi were detected.
- Cerebrovascular events occurred in 6.4% of Group I versus 23% of Group II.
Conclusions:
- Morphological features of ASA do not reliably predict cerebrovascular risk.
- ASA may be an embolic stroke risk factor, but the risk is lower than previously assumed.
Abstract:
OBJECTIVES: The purpose of our investigation was to describe the echocardiographic characteristics of an atrial septal aneurysm (ASA) and associated cardiac abnormalities, to determine whether any echocardiographic characteristics are associated with cerebrovascular events, and to compare the cerebrovascular risk of ASA when it is an isolated and incidental finding with ASA associated with other cardiac abnormalities and diagnostic indications, including a cardiac source of embolus. METHODS: In 1605 consecutive patients referred for transesophageal echocardiography during open heart surgery, we identified 78 patients with ASA as an incidental finding (Group I). During the same period, this anomaly was found in 39 of 8014 consecutive patients referred to the echocardiographic laboratory for various diagnostic reasons (Group II). The frequency of cerebrovascular events and ASA characteristics was compared between these two groups. RESULTS: A total of 117 patients with ASA was included in the study: 60 males and 57 females with a mean age of 66.7 +/- 9.1 years. There were no significant differences in the echocardiographic characteristics of ASA or associated cardiac abnormalities between these two groups; no intracardiac or ASA associated thrombi were detected in either group. While only 6.4% of Group I had a clinical event, 23% of patients in Group II had a stroke or transient ischemic abnormality. CONCLUSIONS: The morphological characteristics of ASA and associated cardiac abnormalities do not distinguish patients at risk for cerebrovascular events. Although the presence of ASA may be a risk factor for embolic strokes, this risk is lower than previously thought.