Racial differences in the prevalence of cardiac sources of embolism in subjects with unexplained stroke or transient ischemic attack evaluated by transesophageal echocardiography

Kizer, Jorge R.; Silvestry, Frank E.; Kimmel, Stephen E.; Kasner, Scott E.; Wiegers, Susan E.; Erwin, Michael B.; Schwalm, Stephanie; Viswanathan, Mohan; Pollard, John R.; Keane, Martin; Sutton, Martin G. St. John

doi:10.1016/s0002-9149(02)02496-7

Cited by 17 publications

(17 citation statements)

References 26 publications

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“…The prevalence of CSE somewhat varies by race [11, 12]. The low frequency of AF in our registry might suggest intrinsic racial differences in susceptibility to the development of AF [11, 12]. However, AF-related strokes constituted 61% of all cardioembolic strokes, similar to those of previous reports [4, 17].…”

Section: Discussionsupporting

confidence: 81%

“…However, this value is lower than that observed in Whites (29%) [10, 11, 17, 18]. The prevalence of CSE somewhat varies by race [11, 12]. The low frequency of AF in our registry might suggest intrinsic racial differences in susceptibility to the development of AF [11, 12].…”

Section: Discussionmentioning

confidence: 60%

“…Determining the exact prevalence of PCSE in stroke patients may require data from the hospital-based stroke registry because the detection of many PCSE depends on the thoroughness of the diagnostic tests performed. In addition, the prevalence of PCSE may be different among regions or races [7,8,9,10,11,12,13]. Therefore, this study used a hospital-based stroke registry in Korea to determine the frequency and coexistent patterns of the high- and medium-risk CSE as defined by the TOAST classification system.…”

Section: Introductionmentioning

confidence: 99%

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Frequency and Significance of Cardiac Sources of Embolism in the TOAST Classification

et al. 2007

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Background: This study was aimed at determining the frequency and coexistent patterns of high- and medium-risk cardiac sources of embolism (CSE) as defined by the Trial of ORG 10172 in the Acute Stroke Treatment (TOAST) classification system and at investigating how identified CSE contributed to this classification. Methods: We analyzed data from 2,482 patients with acute cerebral infarctions who registered in the Yonsei Stroke Registry over a 10-year period. Cardiac sources were divided into high- and medium-risk groups based on the TOAST classification. Results: Of the 2,482 patients, 1,130 (46%) underwent echocardiographic studies. At least one CSE was detected in 629 patients (25%). Atrial fibrillation was the most common high-risk CSE. Patent foramen ovale, spontaneous echo contrast and congestive heart failure comprised most of the medium-risk CSE. Atrial fibrillation frequently accompanied coexistent CSE (69%) such as spontaneous echo contrast, congestive heart failure, and left atrial/appendage thrombus, while patent foramen ovale was detected in isolation in more than 90% of the patients. Patients with a high-risk CSE were more likely to be diagnosed with cardioembolism (83%) than patients with only a medium-risk CSE (58%). Conclusions: Our study elucidated the frequency and various coexistent patterns of CSE in Korean stroke patients as defined by the TOAST classification system. In addition, we have demonstrated a higher correlation between high-risk CSE and cardioembolism than with medium-risk CSE and cardioembolism.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

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Frequency and Significance of Cardiac Sources of Embolism in the TOAST Classification

et al. 2007

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“…As such, the importance of ASA as a risk factor for cryptogenic stroke may not be as significant among blacks as in the other race-ethnic groups. In the only other study that compared TE-defined stroke risk factors in a biracial cohort, Kizer et al 23 found a lower prevalence of PFO among blacks compared with whites. This may be due to the high prevalence of small PFOs among blacks, which may have been difficult to detect.…”

Section: Discussionmentioning

confidence: 97%

Race-Ethnic Differences in Patent Foramen Ovale, Atrial Septal Aneurysm, and Right Atrial Anatomy Among Ischemic Stroke Patients

Rodríguez

Homma

Sacco

et al. 2003

Stroke

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Background and Purpose-Stroke remains a substantial cause of mortality and morbidity in the United States. Racial differences in stroke incidence and mortality persist with well-known excesses among blacks. Information on stroke among Hispanics is limited. In particular, little is known about whether patent foramen ovale (PFO), atrial septal aneurysm (ASA), and other atrial anomalies associated with cryptogenic stroke differ among minority populations. Methods-As a part of the PFO in Cryptogenic Stroke Study, transesophageal echocardiography was performed in a cohort of 630 ischemic stroke patients (mean age, 59Ϯ12 years; 44% women; 45% whites, 35% blacks, 17% Hispanics, 3% other). The prevalences of PFO, ASA, and right atrial (RA) anatomy favoring paradoxical embolization were compared among race-ethnic groups. Statistical analyses used analysis of variance for continuous variables and logistic regression for dichotomous variables with adjustments for age and sex. Results-Age-and sex-adjusted prevalences of PFO and ASA were similar across race-ethnic subgroups. However, large PFO was significantly less prevalent among blacks than among whites (odds ratio, 0.47; 95% confidence interval, 0.24 to 0.91; Pϭ0.02). RA anatomy favoring paradoxical embolization was also significantly less prevalent among blacks compared with whites (odds ratio, 0.62; 95% confidence interval, 0.43 to 0.91; Pϭ0.01). There were no significant differences in prevalence between whites and Hispanics. Conclusions-Although the frequency of PFO did not vary among race-ethnic groups, a large PFO and RA anatomy favoring paradoxical embolization were significantly more prevalent among whites and Hispanics compared with blacks. These may be relatively more important risk factors for stroke among whites and Hispanics than among blacks.

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“…Furthermore, a retrospective review of 196 white and 87 black patients with cryptogenic stroke who underwent transesophageal echocardiography showed the odds of identifying a potential cardioembolic source of embolism in blacks to be less than half the odds for whites. In addition, blacks had nearly quadruple the odds of having moderate or severe left ventricular hypertrophy suggesting undiagnosed hypertensive cerebrovascular disease [7].…”

Section: Stroke Subtypementioning

confidence: 99%

Stroke in black Americans

Ruland

Gorelick

2005

Curr Cardiol Rep

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Black Americans bear a disproportionate stroke burden in the United States compared with other racial and ethnic groups. Poor stroke awareness, higher vascular risk factor burden, limited access to care, mistrust of the medical system, and inequities in diagnostic testing and treatment usage may account for some of the disparity. In addition, blacks have historically been under-represented in observational studies and clinical trials of stroke prevention and treatment. Therefore, our knowledge regarding stroke in black Americans is somewhat limited. This article provides an update on developments in our understanding regarding stroke in this at-risk population.

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Racial differences in the prevalence of cardiac sources of embolism in subjects with unexplained stroke or transient ischemic attack evaluated by transesophageal echocardiography

Cited by 17 publications

References 26 publications

Frequency and Significance of Cardiac Sources of Embolism in the TOAST Classification

Frequency and Significance of Cardiac Sources of Embolism in the TOAST Classification

Race-Ethnic Differences in Patent Foramen Ovale, Atrial Septal Aneurysm, and Right Atrial Anatomy Among Ischemic Stroke Patients

Stroke in black Americans

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