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Mitral valve prolapse as a risk factor for TIA. A study with echocardiography and dynamic ECG
Insights
Mitral valve prolapse (MVP) is a risk factor for focal cerebral ischemia in young patients, particularly those without traditional vascular risks. Further cardiac evaluation is crucial for identifying these cases.
Area of Science:
- Neurology
- Cardiology
- Vascular Medicine
Background:
- Reversible focal cerebral ischemia can occur without apparent cardiopathy or atherosclerosis.
- Vascular risk factors like hypertension and hyperlipemia are common in affected patients.
- A subset of patients with cerebral ischemia lacks identifiable clinical, hematochemical, or cardiological abnormalities.
Purpose of the Study:
- To investigate the role of cardiac abnormalities, specifically mitral valve prolapse (MVP), in patients with unexplained focal cerebral ischemia.
- To determine if MVP is associated with cerebral ischemia in younger individuals or those without conventional vascular risk factors.
Main Methods:
- Analysis of 120 patients with reversible focal cerebral ischemia.
- Clinical, hematochemical, and cardiological examinations.
- Echocardiography and dynamic electrocardiography (Holter monitoring) in specific patient subgroups.
- Assessment of vascular risk factors (hypertension, hyperlipemia).
Main Results:
- 77% of patients had vascular risk factors; 23% had no initial abnormalities.
- Cardiac evaluations identified 6 cases of mitral valve prolapse (MVP), 2 with frequent premature ventricular beats, and 1 with atrial arrhythmia.
- All 6 MVP cases were found in patients without vascular risk factors.
- In patients under 45 years old, MVP occurred in 21.5%.
Conclusions:
- Mitral valve prolapse (MVP) is confirmed as a significant risk factor for focal cerebral ischemia, especially in younger patients.
- The study highlights the importance of cardiac evaluation, including echocardiography, for patients presenting with unexplained cerebral ischemia, even in the absence of traditional risk factors.
- MVP should be considered in the differential diagnosis of ischemic stroke in young adults without typical cardiovascular risk profiles.
Abstract:
The present study has been devoted to the analysis of 120 patients presenting with reversible focal cerebral ischemia without conventional signs of cardiopathy and/or relevant atherosclerotic disease. In 77% of the patients vascular risk factors, such as hypertension or hyperlipemia, were present. In 23% of the patients, no abnormal finding was discovered at clinical, hematochemical and cardiological examinations. In these patients a further cardiological evaluation was performed with echocardiography. Dynamic electrocardiography was performed in 52 patients. Echocardiography and dynamic electrocardiography revealed the occurrence of 6 cases of mitral valve prolapse (MVP), 2 cases of frequent premature ventricular beats, and 1 proximal atrial arrhythmia. All 6 cases of MVP were detected in the subgroups of patients without vascular risk factors. In our patients younger than 45 years, the relative frequency of MVP attains 21.5%. This study confirms that MVP has to be regarded as a risk factor for focal cerebral ischemia in young patients.