Incidence of silent myocardial ischaemia in patients with cerebral ischaemia

Pasquale, Giuseppe Di; Pinelli, G; Grazi, P; Andreoli, A.; Corbelli, C; Manini, G; Urbinati, Stefano; Carini, G

doi:10.1093/eurheartj/9.suppl_n.104

Cited by 38 publications

(22 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Coronary angiography was performed in 2 patients, one with 3-vessel CHD and the other with 2-vessel CHD. In a later report by Di Pasquale et al 8 of 190 consecutive patients with cerebral ischemia but without symptoms or ECG signs of ischemic heart disease, a positive exercise test was found in 26%. Follow-up exercise thallium myocardial scintigraphy was abnormal in 33 of 36 patients, of whom 26 had reversible and 7 had fixed perfusion deficits.…”

Section: Prevalence Of Asymptomatic Chd In Patientsmentioning

confidence: 88%

Coronary Risk Evaluation in Patients With Transient Ischemic Attack and Ischemic Stroke

Adams¹,

Chimowitz²,

Alpert³

et al. 2003

Circulation

226

View full text Add to dashboard Cite

Stroke and myocardial infarction (MI) share common risk factors and pathological mechanisms, and coronary artery disease (CHD) is an important cause of death in patients with cerebrovascular disease. This Scientific Statement addresses issues in management of the relatively healthy patient with brain ischemia (a transient ischemic attack [TIA] or an ischemic stroke) who does not have recognized CHD but often has risk factors in addition to having had a TIA or stroke that indicate an increased likelihood of disability or death from cardiac disease in the future. This Statement should not be confused with the official American College of Cardiology (ACC)/American Heart Association (AHA) practice guidelines. The reader is referred to the ACC/AHA guidelines for management of recognized and symptomatic CHD 1 and the American College of Chest Physicians (ACCP) 2 and American Stroke Association (ASA) 3-5 guidelines for evaluation of cardiac causes of TIA and stroke, which are important related but separate issues.

show abstract

Section: Prevalence Of Asymptomatic Chd In Patientsmentioning

confidence: 88%

Coronary Risk Evaluation in Patients With Transient Ischemic Attack and Ischemic Stroke

Adams¹,

Chimowitz²,

Alpert³

et al. 2003

Circulation

226

View full text Add to dashboard Cite

show abstract

“…Previous studies were based on exercise electrocardiograms or myocardial scintigraphy in patients with stroke or transient ischemic attack. [11][12][13][14][15][16][17][18][19][20][21][22] These small series suggested a prevalence of silent myocardial ischemia as high as 40%. In the present study, which, to our knowledge, is the largest ever using gold standard coronary angiography in nonfatal ischemic strokes, the 62% prevalence of coronary artery plaque and the 26% prevalence of coronary artery stenosis Ն50% was consistent with the 70% prevalence and 29% prevalence, respectively, found in a previous autopsy series of fatal stroke without coronary heart disease history.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Coronary Atherosclerosis in Patients With Cerebral Infarction

Amarenco

Lavallée

Labreuche

et al. 2011

Stroke

154

122

View full text Add to dashboard Cite

Background and Purpose-There is an overlap between stroke and coronary heart disease, but the exact prevalence of coronary artery disease in patients with nonfatal cerebral infarction is unclear, particularly when there is no known history of coronary heart disease. Methods-We consecutively enrolled 405 patients presenting with acute cerebral infarction documented by neuroimaging who underwent carotid and femoral artery, thoracic, and abdominal aorta ultrasound examinations.Of the 342 patients with no known coronary heart disease, 315 underwent coronary angiography a median of 8 days (interquartile range, 6 -11) after stroke onset. Results-Coronary plaques on angiography, regardless of stenosis severity, were present in 61.9% of patients (95% confidence interval [CI], 56.5-67.3) and coronary stenoses Ն50% were found in 25.7% (95% CI, 20.9 -30.5). The overall prevalence of coronary plaque increased with the number of arterial territories (carotid or femoral arteries) involved, with an adjusted odds ratio of coronary artery disease of 1.25 (95% CI, 0.58 -2.71) for presence of plaque in 1 territory, and 4.31 (95% CI, 1.92-9.68) for presence of plaque in both territories, compared with no plaque in either territory. The presence of plaque in both femoral and carotid arteries had an age-and sex-adjusted positive predictive value of 84% for presence of coronary plaque and a negative predictive value of 44%. Conclusions-There is a high burden of silent coronary artery disease in patients with nonfatal cerebral infarction and no known coronary heart disease, even in the absence of systemic atherosclerosis. The prevalence is even higher in patients with evidence of carotid and/or femoral plaque. (Stroke. 2011;42:22-29.)

show abstract

“…In a few crosssectional studies, asymptomatic CAD (detected by noninvasive cardiac tests) was more common in patients with stroke attributable to atherosclerosis than in those with other stroke subtypes. [27][28][29] However, those studies either were small 29 or enrolled selected populations. 27,28 In patients with suspected CAD scheduled for conventional coronary angiography, CAD was found to be more common in those with carotid artery disease.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Asymptomatic Coronary Artery Disease in Ischemic Stroke Patients

et al. 2010

View full text Add to dashboard Cite

Background-Coronary artery disease (CAD) is a significant cause of morbidity and mortality in stroke patients. Some patients with asymptomatic CAD might benefit from specific prevention, but the prevalence of asymptomatic CAD is not well known. We assessed the prevalence of Ն50% asymptomatic CAD in patients with ischemic stroke or transient ischemic attack and whether the prevalence is related to traditional vascular risk factors and cervicocephalic atherosclerosis. Methods and Results-From January 2006 to February 2009, consecutive patients between 45 and 75 years of age with nondisabling, noncardioembolic ischemic stroke or transient ischemic attack and no prior history of CAD were enrolled in the study. All patients had a 64-section computed tomography coronary angiography and a detailed cervicocephalic arterial workup. Risk factors were assessed individually and through the Framingham Risk Score. Among 300 patients included in the study, 274 had computed tomography coronary angiography. The prevalence of Ն50% asymptomatic CAD was 18% (95% confidence interval [CI], 14 to 23; nϭ50). Asymptomatic CAD was independently associated with traditional risk factors assessed individually and through the Framingham Risk Score (odds ratio [OR], 2.6; 95% CI, 1.0 to 7.6 for a 10-year risk of coronary heart disease of 10% to 19%; and OR, 7.3; 95% CI, 2.8 to 19.1 for a 10 year-risk of coronary heart disease Ն20%), the presence of at least 1 Ն50% cervicocephalic artery stenosis (OR, 4.0; 95% CI, 1.4 to 11.2), excessive alcohol consumption (OR, 3.1; 95% CI 1.3 to 7.3), and ankle brachial index Ͻ0.9 (OR, 2.2; 95% CI, 0.9 to 5.2). The prevalence of Ն50% asymptomatic CAD was also related to the extent of cervicocephalic atherosclerosis. Conclusions-About one fifth of patients with nondisabling, noncardioembolic ischemic stroke or transient ischemic attack have Ն50% asymptomatic CAD. In addition to vascular risk factors, the presence of Ն50% cervicocephalic artery stenosis is strongly related to Ն50%

show abstract

Incidence of silent myocardial ischaemia in patients with cerebral ischaemia

Cited by 38 publications

References 0 publications

Coronary Risk Evaluation in Patients With Transient Ischemic Attack and Ischemic Stroke

Coronary Risk Evaluation in Patients With Transient Ischemic Attack and Ischemic Stroke

Prevalence of Coronary Atherosclerosis in Patients With Cerebral Infarction

Prevalence of Asymptomatic Coronary Artery Disease in Ischemic Stroke Patients

Contact Info

Product

Resources

About