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Mitral valve strands in patients with focal cerebral ischemia
F D Tice1, A P Slivka, E T Walz
1Department of Internal Medicine, Ohio State University, Columbus 43210, USA.
Background And Purpose:
Filamentous strands attached to the mitral valve are a recently described finding in occasional patients undergoing transesophageal echocardiography (TEE), but the frequency and clinical significance of these strands remain poorly defined. The purpose of the present study was to review the prevalence of mitral valve strands in patients undergoing TEE examination and to explore the relation of these strands to cardioembolic cerebral ischemia.
Methods:
All patients with native mitral valves referred for clinically indicated TEE over a 2-year period at our institution were evaluated for the presence of mitral valve strands (defined as highly mobile filamentous masses <1 mm thick attached to the atrial surface of mitral leaflets).
Results:
Of 968 study patients, mitral valve strands were identified in 22 individuals (2.3%). Mitral valve strands were significantly more common in patients referred for TEE as a result of a recent ischemic cerebrovascular event compared with patients referred for other study indications (6.3% versus 0.3%, respectively; P<.00001). Among patients < or = 50 years of age with likely cardioembolic stroke or transient ischemic attack, 16% were found to have mitral valve strands on TEE examination. In 9% of these young patients, no other TEE finding associated with cardioembolic risk was present.
Conclusions:
Filamentous strands attached to the mitral valve appear to represent another risk factor for embolic cerebral ischemia, particularly in patients < or = 50 years of age.
Insights
Mitral valve strands, mobile filamentous masses on heart valves, are a newly identified risk factor for cardioembolic stroke. These strands were found in 2.3% of patients undergoing transesophageal echocardiography (TEE).
Area of Science:
- Cardiology
- Neurology
- Echocardiography
Background:
- Filamentous strands on the mitral valve are a recently identified echocardiographic finding.
- The prevalence and clinical significance of these mitral valve strands are not well-established.
Purpose of the Study:
- To determine the prevalence of mitral valve strands in patients undergoing transesophageal echocardiography (TEE).
- To investigate the association between mitral valve strands and cardioembolic cerebral ischemia.
Main Methods:
- Evaluation of patients with native mitral valves undergoing clinically indicated TEE over a 2-year period.
- Definition of mitral valve strands as mobile filamentous masses (<1 mm thick) on the atrial surface of mitral leaflets.
Main Results:
- Mitral valve strands were identified in 2.3% of 968 patients.
- Strands were significantly more prevalent in patients referred for TEE due to recent ischemic cerebrovascular events (6.3% vs. 0.3%).
- In patients ≤50 years with likely cardioembolic stroke/TIA, 16% had strands, with 9% having no other identified cardioembolic risk factor.
Conclusions:
- Mitral valve strands represent a potential risk factor for embolic cerebral ischemia.
- This association is particularly notable in younger patients (≤50 years of age).