Higher prevalence of atrial septal aneurysms in patients with ischemic stroke of unknown cause

Abstract

Atrial septal aneurysms (ASA) are frequent findings on transesophageal echocardiographies. Whether they are more frequent in patients with cerebral ischemia of unknown cause remains unclear. We investigated this question in 154 consecutive patients with an ischemic stroke or transient ischemic attack. The 16 patients with ASA were younger, less likely to have arterial hypertension and more likely to have a patent foramen ovale (PFO) or an unknown cause of stroke, but they did not differ for number and side of infarcts, other demographic data and vascular risk factors. Patients with ASA unassociated to PFO were also more likely to have an unknown cause of stroke. These findings lead to the hypothesis that ASA might be sources of cerebral emboli.

RESEARCH FROM THE UNIVERSITY OF ALABAMA AT BIRMINGHAM: Patent Foramen Ovale in a Large Population of Ischemic Stroke Patients: Diagnosis, Age Distribution, Gender, and Race

“…Atrial septal aneurysm, an out pouching defect of the atrial septum, is also strongly associated with ischemic stroke 5,14,39–42 . The incidence has been reported to be about 1% in autopsy studies, 1–1.3% in the general population, and approximately 5–12% in echocardiographic studies among ischemic stroke patients 15,39,40,43,44 . In our study, about 2% of the patients had ASA, and another 2.5% had a hypermobile septum.…”

“…In our study, about 2% of the patients had ASA, and another 2.5% had a hypermobile septum. This is a higher percentage than the autopsy studies but much lower than other echocardiographic studies 15,39,40,43,44 . ASAs are also thought to be more common in younger patients with ischemic stroke but does occur in all age groups 3,31,32 .…”

Echocardiographic Evaluation of the Left Atrium and Left Atrial Appendage Function in Patients with Atrial Septum Aneurysm - Implications for Thromboembolic Complications

“…Such factors include the heart rate, duration of diastole, atria enlargement as a consequence of various heart anomalies, left ventricle preload and afterload, left ventricle and LA contractility, blood pressure, and the coexistence of pericardial diseases [25,26]. It was important to try and eliminate these numerous factors, but the fact that ASA is usually accompanied by other heart anomalies [12] made it difficult to select a representative group of patients with isolated ASA as it is usually accompanied by PFO, ASD [3,9] or MVP [27].…”

Importance of Performing Transesophageal Echocardiography in Acute Stroke Patients older than Fifty

“…Transesophageal echocardiography (TEE) has been proven to be more sensitive than transthoracic echocardiography (TTE) in diagnosing intracardiac sources of emboli 5–10 . The use of TEE has greatly contributed to the identification of cardiac disorders that are now considered potential causes of stroke such as patent foramen ovale, atrial septal aneurysm, complex aortic atheromatous plaque (>4 mm in thickness), and intracavitary thrombi 11–14 . TEE has been reported to be unwarranted because it does not change the management in patients older than 65 years presenting with acute stroke 15 .…”

“…[5][6][7][8][9][10] The use of TEE has greatly contributed to the identification of cardiac disorders that are now considered potential causes of stroke such as patent foramen ovale, atrial septal aneurysm, complex aortic atheromatous plaque (>4 mm in thickness), and intracavitary thrombi. [11][12][13][14] TEE has been reported to be unwarranted because it does not change the management in patients older than 65 years presenting with acute stroke. 15 This was attributed to the poorly defined treatment of atrial septal aneurysm (ASA) with or without patent foramen ovale (PFO) and of complex aortic atheromas.…”