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Association between stroke and atrial septal aneurysm assessed by transesophageal echocardiography in a cardiologic
M Ossemann1, P Laloux, B Marchandise
1Department of Neurology, Mont-Godinne University Hospital, Louvain Medical School, Yvoir, Belgium.
Insights
Atrial septal aneurysm (ASA) is a recognized source of emboli. This study found ASA is more prevalent in patients with cerebrovascular events and increases stroke risk when associated with an interatrial shunt.
Area of Science:
- Cardiology
- Neurology
- Vascular Medicine
Background:
- Atrial septal aneurysm (ASA) is increasingly identified as an embolic source.
- The prevalence of ASA in the general population requires further investigation.
- Understanding ASA's association with cerebrovascular events is crucial for risk stratification.
Purpose of the Study:
- To determine the prevalence of ASA in a cardiology patient cohort.
- To investigate the association between ASA and cerebrovascular events (stroke, TIA, peripheral emboli).
- To evaluate the impact of interatrial shunting and age on ASA-related vascular events.
Main Methods:
- Transesophageal echocardiography with contrast was performed on 494 consecutive patients.
- Patients were divided into two groups: with (A) and without (B) cerebrovascular events.
- Prevalence of ASA was compared between groups and analyzed across clinical presentations and age demographics.
Main Results:
- ASA was detected in 38 patients (8% prevalence).
- ASA prevalence was significantly higher in patients with cerebrovascular events (16%) compared to controls (4%) (p < 10(-5)).
- The risk of vascular events increased significantly when ASA was present with an interatrial shunt.
Conclusions:
- Atrial septal aneurysm is a potential source of cerebrovascular events across various clinical presentations and age groups.
- The presence of an interatrial shunt amplifies the stroke risk in individuals with ASA.
- These findings underscore the importance of screening for ASA in patients with embolic events.
Abstract:
Atrial septal aneurysm (ASA) is now recognized as a source of emboli. Its prevalence in a general population remains controversial. We assessed, in a cardiologic population, the prevalence of ASA, the association with cerebrovascular events, the role of associated interatrial shunting and age. Four hundred and ninety-four consecutive patients were referred for transesophageal echocardiography with contrast. The prevalence of ASA in two groups, with (A) and without (B) cerebrovascular events were compared. In group A, we studied the prevalence of ASA according to the clinical presentation (stroke, TIA and peripheral emboli in limbs). An ASA was found in 38 patients (8%). The prevalence of ASA was higher in group A (16%) than in group B (4%) (p < 10(-5)). Prevalence of ASA was not significantly different in stroke, TIA and peripheral emboli subgroups. There was no difference in prevalence of ASA in stroke or TIA subgroups according whether age was < 55 years or > or = 55 years. Prevalence of all types of vascular events was increased when ASA was associated with an interatrial shunt. Our results support the assumption that ASA is a potential source of cerebrovascular events, whatever the clinical presentation or age. Presence of interatrial shunt increases the risk of stroke in subjects with ASA.