Cardiac abnormalities in stroke patients with negative arteriograms.

Abstract

SUMMARY Sixty-five consecutive patients with recent unequivocal TIA (33) or stroke (32), but nondiagnostic arteriograms, had two-dimensional echocardiograms (2DE) and electrocardiograms (ECG) to determine the incidence of cardiac abnormalities which could cause embolic stroke. Abnormalities were classified according to increasing probability of causing an embolic event: non-specific, possible emboligenic abnormality (PEA) or definite emboligenic abnormality (EA).Although 2DE was abnormal in 33 patients (51%), and ECG in 38 (59%), many abnormalities were nonspecific. Only four patients (6%) had EA on ECG and two (3%) on 2DE. Since one patient had EA on both tests, 2DE identified only one patient (mitral valve prolapse) not already identified by ECG. All patients with EA had a prior history of cardiac disease. PEA was present on ECG in 11 patients (17%), and on 2DE in 25 (38%). There was no correlation between age, CT results, or neurologic symptoms commonly associated with embolic stroke and the presence of EA or PEA on ECG or 2DE.Although TIA and stroke patients with negative arteriograms have a high incidence of abnormalities on ECG and 2DE, the percentage of patients with EA is low, and cardiac history and ECG identify most patients. 2DE provides little additional information.

Anticardiolipin Antibody and Stroke: Possible Relation of Valvular Heart Disease and Embolic Events

“…This conclusion is con sistent with several recent case reports and small series describing échocardiographie, autopsy and cerebral imaging data among patients with Ada [5,7] or lupus anticoagu lant [25][26][27][28][29][30][36][37][38][39][40] and ischemic neurologic events: a possible association with valvular disease is readily inferrable from these re ports. Importantly, the frequency of poten tially emboligenic échocardiographie valvu lar abnormalities among our entire group of Acla-positive patients with stroke (80%) is considerably higher than that expected among patients not selected for Ada with non-hemorrhagic stroke (0-11%) [33,41,42] and also is higher than the frequency of all échocardiographie abnormalities in unse lected stroke populations (4-16%) [43], even among younger stroke patients most compa rable in age to our series (21-33%) [14,41,44], It must be noted again, however, that the small size of the present series precludes confident comparison with these earlier studies.…”

Carotid transient ischemic attacks and normal investigations: a follow-up study.

“…However, other studies have suggested a low incidence of cardiac disease in TIA patients with normal cerebral angiograms. 7 With wider availability of newer technology, it is not unusual to find cerebral infarcts on cranial computed tomograms (CT scans) or abnormalities during cardiac or hematologic evaluations that may explain the transient cerebral symptoms even if the angiograms are normal. While there are several reports of TIA patients with normal angiograms, there have to date been no publications specifically reviewing the longterm follow-up of TIA patients with normal cerebral, cardiac, and hematologic findings.…”

Can Transient Drop in Blood Pressure in High-Risk Hypertensive Patients Cause Small Cerebral Infarcts?

“…Although TEE, which is superior to TTE in detecting some cardiac embolic sources, was not done in all patients, it is unlikely that cardiac embolic sources were undetected because previous studies have shown that TEE is unlikely to reveal any abnormalities when there is no clinical evidence of cardiac disease and TTE is negative, as in all Group 1 patients [25,26]. Aortic atheroma is also an unlikely embolic source in our study because none of the 24 patients (in all groups) who underwent TEE in our analysis had evidence of complex aortic atheromas [27], and no patient had evidence of concurrent systemic embolism.…”