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Published on: February 4, 2021
Calcific aortic valve and spontaneous embolic stroke: a review of literature
Vipin Khetarpal1, Nitin Mahajan, Ramesh Madhavan
1Division of Cardiology, Wayne State University, Detroit, MI-48201, USA.
Insights
Aortic valve calcification is linked to stroke, but this connection is poorly understood. Further research is needed to clarify the association between aortic valve calcification and stroke risk.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Aortic valve calcification is prevalent in older adults and those with bicuspid aortic valves.
- Unlike mitral valve disease, aortic valve calcification is not widely recognized as a stroke risk factor.
- Autopsy studies suggest systemic embolism in a third of calcific aortic valve cases, but clinical data remain conflicting.
Purpose of the Study:
- To review the current literature on the association between aortic valve calcification and stroke.
- To highlight the limited reported cases of symptomatic stroke due to cerebral thromboembolism from calcific aortic valves.
- To discuss diagnostic modalities and the undefined management strategies for this condition.
Main Methods:
- Focused literature review.
- Analysis of existing studies on aortic valve calcification and stroke.
- Review of diagnostic imaging techniques like CT angiography and MRI.
Main Results:
- Limited documented cases (8) of symptomatic stroke from cerebral thromboembolism linked to aortic valve calcification.
- Conflicting data from clinical studies regarding the association between aortic valve calcification and stroke.
- Diagnostic imaging (CT, MRI) plays a key role in identifying calcific embolism and ischemic extent.
Conclusions:
- The relationship between aortic valve calcification and stroke requires further investigation.
- Management strategies, including antiplatelet therapy, anticoagulation, and valve replacement, are not well-defined.
- Enhanced understanding is crucial for patient care and risk stratification.
Abstract:
Aortic valve calcification is common in the elderly and in patients with congenital bicuspid aortic valve but unlike calcific mitral valve disease it is not a well recognized risk factor for stroke. Although autopsy studies have revealed evidence of systemic embolism in one-third of cases with calcific aortic valves, there is conflicting data from larger clinical studies examining the association between calcific aortic valve and stroke. There are only 8 reported cases of symptomatic stroke from spontaneous cerebral thromboembolism associated with calcific aortic valve in the literature. Computerized tomography (CT) angiography and CT without contrast are modalities of choice to diagnose calcific embolism, while MRI may be useful in delineating the extent of ischemia. Ideal management strategy, the role of antiplatelet therapy, anticoagulation or recommendations for valve replacements are poorly defined. We present a focused literature review on this topic.
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