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[Echocardiographic changes associated with risk of developing embolic complications in patients with ischemic stroke]
Insights
Echocardiography reveals cardiac abnormalities linked to embolic complications in all ischemic stroke subtypes. Cardioembolic stroke patients frequently show mitral valve issues and left atrial dilation, highlighting echocardiography
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Ischemic stroke (IS) encompasses various pathogenetic subtypes, with cardioembolic stroke posing a significant risk.
- Identifying echocardiographic markers is crucial for predicting embolic complications in IS patients.
Purpose of the Study:
- To investigate echocardiographic parameters associated with embolic complications in patients with cardioembolic and other pathogenetic subtypes of ischemic stroke.
Main Methods:
- A cohort of 330 ischemic stroke patients was analyzed.
- Transthoracic echocardiography was performed on all patients; transesophageal echocardiography was conducted in 53 patients.
- Patients were categorized into cardioembolic stroke (n=104) and other subtypes (n=226).
Main Results:
- Cardiac pathology was prevalent (66.7%), with ischemic heart disease noted in approximately 50% of both groups.
- Infectious-inflammatory diseases were more common in the cardioembolic group (27.9% vs. 4.4%, p < 0.0001).
- Specific findings like mitral valve prolapse, aneurysm, and interatrial defects were significantly higher in the cardioembolic group (25.0% vs. 5.3%, p < 0.0001). Left atrial myxoma was observed in 1.9% of cardioembolic patients.
Conclusions:
- Echocardiographic findings indicative of embolic risk are present across all ischemic stroke subtypes.
- Cardioembolic stroke frequently demonstrates mitral valve prolapse with myxomatous degeneration, vegetations, failure, mitral ring calcification, left ventricular hypokinesis, and left atrial dilation/thrombosis.
- Less common but significant echocardiographic findings associated with cerebral embolism include prosthetic valves, mitral stenosis, cardiac tumors, and septal defects.
Aim:
To study echocardiographic parameters associated with embolic complications in patients with cardioembolic and other pathogenetic subtypes of ischemic stroke.
Material And Methods:
330 patients with ischemic stroke (IS) were examined. Transthoracal echocardiography was made in all the patients, transesophageal echocardiography was performed in 53 (16.1%) patients. The patients were divided into two groups: 104 (31.5%) patients who survived cardiocerebral embolism (group 1), 226 (68.5%) patients with other pathogenetic subtypes of stroke (group 2).
Results:
Cardiac pathology was detected in 220 of 330 (66.7%) examinees with ischemic heart disease in 50.0% and 51.3% patients of group 1 and 2, respectively; infectious-inflammatory diseases--in 27.9 and 4.4%, respectively (p < 0.0001), other diseases (mitral prolapse, aneurysm and interatrial defect, idiopathic arhythmia) in 25.0 and 5.3% patients, respectively (p < 0.0001). Left atrial myxoma was diagnosed in 1.9% patients of group 1.
Conclusion:
Echocardiographic changes associated with a risk of embolic complications were visualized in all pathogenetic subtypes of ischemic stroke. In cardioembolic stroke echocardiography detected most frequently prolapse with myxomatous degeneration of the cusps and mitral vegetations, mitral failure, calcinosis of the mitral ring, local hypokinesia of the left ventricle, dilation and thrombosis of the left atrium. Rare changes, indicating cerebral embolism, include replaced aortic and mitral valves, mitral stenosis, cardiac tumor, aneurysm and defect of the interatrial septum.