Impact of Valvular Thickness on Stroke Recurrence in Medically Treated Patients with Stroke

Abstract

Background: It remains controversial whether left-sided valvular thickening (VaT) is a risk factor for ischemic stroke. Little is known about the relationship between VaT and the recurrent adverse event rate in medically treated patients with stroke. Methods: We examined the outcomes of 627 noncardioembolic stroke patients who were double-blindly assigned to either warfarin or aspirin therapy and assessed VaT using transesophageal echocardiography. Endpoints were recurrent ischemic stroke or death from any cause. The Cox proportional hazards model was used to adjust for covariates. Results: VaT was present in 57.3% of the patients (359/627), 34.6% (271/627) involving the aortic valve and 46.4% (291/627) involving the mitral valve. There was no difference in the time to primary endpoints between those with and without VaT of the aortic valve (p = 0.49; hazard ratio, HR: 1.17; 95% CI: 0.74–1.85; 2-year event rates: 18.9 vs. 13.2%) or mitral valve (p = 0.66; HR: 0.91; 95% CI: 0.60–1.38; 2-year event rates: 16.9 vs. 14.7%). Among the patients with VaT, there was no significant difference in the time to primary endpoints between those treated with warfarin and those with aspirin (p = 0.13, HR: 0.65, 95% CI: 0.37–1.14, 2-year event rates: 15.2 vs. 22.7% for the aortic valve; p = 0.22, HR: 0.70, 95% CI: 0.40–1.23, 2-year event rates: 14.2 vs. 19.6% for the mitral valve). Conclusions: VaT does not appear to increase recurrent adverse event rates in medically treated patients with ischemic stroke, regardless of warfarin or aspirin therapy.

Calcific aortic valve and spontaneous embolic stroke: A review of literature

“…However, in the presence of inherited thrombophilia and absence of venous thrombosis, long term anticoagulants or antiplatelet therapy is recommended (Class IIa) [47]. Recently a sub group analysis of the Warfarin Aspirin Recurrent Stroke Study (WARSS) failed to document any benefit of anticoagulation over aspirin in patients with aortic valve sclerosis [48]. Anticoagulation has no effect on spontaneous calcific embolism, but may be useful to prevent microthrombus formation.…”