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Mitral valve prolapse and the risk of stroke after initial cerebral ischemia
A J Orencia1, G W Petty, B K Khandheria
1Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA.
Insights
Patients with cerebral ischemia and mitral valve prolapse (MVP) face no increased risk of recurrent stroke. This population-based study found similar stroke recurrence rates compared to the general population.
Area of Science:
- Neurology
- Cardiology
- Epidemiology
Background:
- Referral studies indicate a higher risk of recurrent cerebral ischemic events in patients with cerebral ischemia and mitral valve prolapse (MVP).
- The association between MVP and recurrent stroke risk requires further investigation in population-based cohorts.
Purpose of the Study:
- To determine the risk of subsequent stroke in a population-based group of patients diagnosed with ischemic stroke or transient ischemic attack (TIA) and MVP.
Main Methods:
- A cohort of 49 Olmsted County residents with initial ischemic stroke or TIA and echocardiographically diagnosed MVP (1975-1990) was identified.
- The risk of subsequent stroke was compared to age- and sex-adjusted rates of recurrent stroke in the Rochester, MN population.
Main Results:
- Nine patients (5.5 per 100 person-years) experienced a subsequent stroke.
- The observed risk was not significantly different from expected rates in the general population (relative risk 0.84 and 0.73 for different comparison groups).
Conclusions:
- There is no evidence of increased subsequent stroke risk in patients with cerebral ischemia and MVP compared to age- and sex-adjusted community rates.
- Findings suggest MVP may not be an independent risk factor for recurrent stroke.
Abstract:
Referral-based studies suggest that patients with cerebral ischemia and mitral valve prolapse are prone to recurrent cerebral ischemic events. Our purpose was to determine the risk of subsequent stroke in a population-based group of patients with ischemic stroke or TIA and mitral valve prolapse. From 1975 through 1990, 49 residents of Olmsted County, MN, had an initial ischemic stroke or TIA and echocardiographically diagnosed mitral valve prolapse. Risk of subsequent stroke in this cohort was compared with the age- and sex-adjusted rates of recurrent stroke after initial cerebral ischemia in the Rochester, MN, population. Mean age of the patients was 72 years. Thirty-one (63%) were women. Nine had subsequent stroke (5.5 per 100 person-years). For Rochester patients who had initial ischemic stroke in the period 1975 through 1984, 10.72 recurrent strokes were expected (relative risk, 0.84; 95% confidence limits, 0.38 to 1.59). For Rochester patients with initial ischemic stroke or TIA in the period 1975 through 1979, 12.31 recurrent strokes were expected (relative risk, 0.73; 95% confidence limits, 0.33 to 1.39). There is no evidence of increased subsequent stroke risk among patients with initial episodes of cerebral ischemia and mitral valve prolapse relative to the age- and sex-adjusted recurrent stroke rates in the community.