Related Experiment Videos
Course of valvular strands in patients with stroke: cooperative study with transesophageal echocardiography
N Nighoghossian1, L Derex, M Perinetti
1Department of Neurology, Cerebrovascular Disease and Ataxia Research Center, Pierre Wertheimer Hospital Lyon, France.
Insights
Native valve strands, often linked to stroke, typically persist over time, indicating chronic valvular changes rather than acute thrombosis. Serial echocardiography confirms strand persistence in most patients.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Native valve strands may represent acute thrombosis or chronic valvular changes.
- The association between native valve strands and stroke requires further investigation.
Purpose of the Study:
- To evaluate the changes in native valve strands in patients experiencing stroke using serial transesophageal echocardiography (TEE).
Main Methods:
- A cohort of patients referred for TEE due to stroke or cardiac pathology was studied.
- Transesophageal echocardiography was performed at baseline and repeated after 3 months for patients with stroke.
- Valvular strand presence, location, and valve morphology were assessed.
Main Results:
- Valvular strands were significantly more prevalent in patients with stroke (18.8%) compared to cardiac patients (2.2%).
- Strands were most commonly found on the mitral valve.
- In a follow-up TEE after 3 months, native valve strands persisted in the majority of patients (84.6%).
Conclusions:
- Native valve strands are frequently associated with stroke and usually represent chronic valvular changes.
- Valvular thickening or redundancy may predispose to strand formation.
Background:
Native valve strands might be related to the acute stage of thrombosis or might suggest a long-term valvular change. We aimed to estimate changes in the strands in patients with stroke through a serial transesophageal echocardiographic (TEE) study.
Methods And Results:
A study was conducted among patients who were referred for TEE for stroke or cardiac pathology. Patients had TEE examinations with a 5-MHz multiplane TEE probe. Echocardiography was repeated 3 months later in patients with stroke. TEE was performed in 180 patients admitted to cardiology units and in 160 patients referred to neurology units. Among 34 patients with valvular strands, 30 were referred to neurology for stroke, whereas 4 patients were admitted to cardiology (18.8% versus 2.2%, difference 16.5%, 95% confidence interval 10% to 22.9%, P =.001). Strands were located on the mitral valve in 16 patients, the aortic valve in 6 patients, and both left heart valves in 8 patients. Among the 38 valves with strands, 17 (44. 7%) were morphologically normal, 4 (10.5%) were thickened, 7 (18.4%) were redundant, and 10 (26.3%) had both abnormalities. TEE showed other abnormalities in 16 (53.3%) patients, whereas 14 patients had only strands. Twenty-six (86.6%) patients had a second TEE study 3 months later. Strands were not found in 4 (15.4%) patients (95% confidence interval 4.3% to 34.9%).
Conclusions:
Valvular thickening or redundancy may predispose valves to strand formation. Native valve strands usually persist and thus reflect a chronic valvular change.