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Valvular strands and cerebral ischemia. Effect of demographics and strand characteristics
J K Roberts1, I Omarali, M R Di Tullio
1Department of Neurology, Columbia-Presbyterian Medical Center, New York, NY 10032, USA. hommash@medicine1.cpmc.columbia.edu
Insights
Valvular strands, thin filaments on heart valves, are linked to ischemic stroke. This association is particularly strong in younger individuals and affects both men and women across different ethnicities.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Echocardiography
Background:
- Valvular strands, filamentous material on heart valves, are detected via transesophageal echocardiography.
- Previous research suggests an association between valvular strands and stroke, but subgroup data is limited.
Purpose of the Study:
- To investigate the association between valvular strands and cerebral ischemia.
- To analyze this association across different age, sex, and race-ethnic subgroups.
- To determine the impact of strand characteristics (location, length, number, valve thickness) on stroke risk.
Main Methods:
- A case-control study involving 73 patients with recent ischemic stroke or transient ischemic attack (TIA) and 73 age-matched controls.
- Transesophageal echocardiography was used to identify valvular strands.
- Statistical analysis evaluated the association between strands and cerebral ischemia, including subgroup and characteristic analyses.
Main Results:
- Valvular strands were significantly associated with cerebral ischemia (OR=4.4).
- The association was consistent across sexes and race-ethnic groups.
- A stronger association was observed in younger individuals (age < 60: OR=12.5) and for strands on both mitral and aortic valves.
Conclusions:
- Valvular strands, regardless of location (mitral or aortic), are a risk factor for ischemic stroke.
- The risk associated with valvular strands is more pronounced in younger populations.
Background And Purpose:
Valvular strands, thin filamentous material attached to the mitral or aortic valve, are seen during transesophageal echocardiography and have been associated with stroke. Little is known about this association in different age, sex, and race-ethnic subgroups and the effect of various strand characteristics on this association.
Methods:
From patients referred for transesophageal echocardiography, 73 patients with recent ischemic stroke (68) or transient ischemic attack (5) were age matched to 73 stroke- and transient ischemic attack-free control subjects. The association between valvular strands and cerebral ischemia was evaluated for the overall group and demographic subgroups. The effect of strand location, length, number, and valve thickness was also determined.
Results:
An association between cerebral ischemia and valvular strands was observed (odds ratio [OR] = 4.4; 95% confidence interval [CI] = 2.0 to 9.6). The association was found for both men and women and among all three race-ethnic groups. The OR was greater in those who were younger (12.5 [95% CI = 2.4 to 64.5] for age < 60, 4.8 [95% CI = 1.3 to 18.2] for age 60 to 69, and 1.8 [95% CI = 0.5 to 6.4] for age > or = 70 years). Strands on both the mitral (OR = 3.5; 95% CI = 1.5 to 7.9) and aortic (OR = 3.7; 95% CI = 1.1 to 11.9) valve were associated with cerebral ischemia, whereas the number and length of strands were not. The effect of strands was independent of mitral or aortic valve thickness.
Conclusions:
Valvular strands, whether mitral or aortic, are associated with ischemic stroke, especially among younger persons.