Risk of Stroke With Mitral Valve Prolapse in Population-Based Cohort Study

Aj, Orencia; Gw, Petty; Bk, Khandheria; Jf, Annegers; Dj, Ballard; Jd, Sicks; Wm, O'Fallon; Jp, Whisnant

doi:10.1161/01.str.26.1.7

Cited by 54 publications

(18 citation statements)

References 36 publications

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“…Aortic stenosis is found in 1% of all patients with stroke [5][6][7][8][9][10][11][12][13][20][21][22], and calcific cerebral or retinal emboli have been documented [68,69]. Whilst a risk factor for cerebral ischemia in some papers [13,14], mitral valve prolapse carries a low prevalence in other stroke cohorts [8,38,51], and shows no additional risk in case control studies [70,71]. Mitral annular calcification is commonly seen in the healthy elderly population, as well as those with stroke.…”

Section: Alternative Sources Of Embolimentioning

confidence: 99%

Role of routine transthoracic echocardiography in evaluation and management of stroke

Beattie

Cohen

Manning³

et al. 1998

Journal of Internal Medicine

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Objective. To determine the value of routine transthoracic echocardiography in patients with cerebral ischemia without known cardiac disease. Design. The literature from 1990 to 1995 was searched and relevant bibliographies from these papers reviewed. Articles reporting the prevalence and/or risk of stroke for myxoma, vegetation, mitral stenosis, left atrial thrombus, left ventricular thrombus or cardiomyopathy, patent foramen ovale, and atrial septal aneurysm were used. Prevalences and recurrent stroke risk were examined for adult patients less than and greater than 45 years.Results. Both the prevalence of transthoracic echocardiographic findings and recurrent risk of stroke differ by age. The finding of a patent foramen ovale can be expected in nearly half of younger patients with stroke, whilst transthoracic echo can be expected to yield no relevant lesion in three quarters of patients > 45 years. Warfarin anticoagulation appears beneficial in patients with mitral stenosis, left atrial thrombus, left ventricular thrombus, and left ventricular dysfunction, but is of unproven benefit for patent foramen ovale, atrial septal aneurysm, or in the absence of a risk-associated abnormality. Conclusion. For most transthoracic echo findings in stroke, optimal management strategies have not been well defined. Future research is needed to evaluate the appropriate therapeutic approaches.

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Section: Alternative Sources Of Embolimentioning

confidence: 99%

Role of routine transthoracic echocardiography in evaluation and management of stroke

Beattie

Cohen

Manning³

et al. 1998

Journal of Internal Medicine

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“…However, it should be recognized that the contribution of these minor cardiac abnormalities to ischemic stroke is still uncertain [12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31]. …”

Section: Discussionmentioning

confidence: 99%

Lacunar Stroke: Transoesophageal Echocardiographic Factors Influencing Long-Term Prognosis

Kazui¹,

Levi²,

Jones³

et al. 2001

Cerebrovasc Dis

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Objective: Since little is known concerning factors which may influence long-term prognosis of patients presenting with lacunar stroke, we conducted a longitudinal study of this stroke subtype. Variables likely to affect outcome were assessed at baseline, including those from transoesophageal echocardiographic studies. Methods: Consecutive patients presenting with first-ever lacunar stroke underwent diagnostic workup that included brain CT or MRI, carotid duplex, and transthoracic and transoesophageal echocardiography. An assessment of patients was planned at entry (baseline), and thereafter every 12 months (clinic visit or telephone call), drop-out, or endpoint. The primary endpoint was nonfatal or fatal stroke. Secondary endpoint was death due to any cause. Results: Among 60 consecutive lacunar patients with the mean follow-up period of 3.9 years, 12 patients (20%) had stroke recurrence. The mean annual rate for stroke was 5.2%, and for death 2.8%. For multivariate Cox proportional hazards analysis, the following three variables with the values of p < 0.1 after univariate testing were chosen: age (p = 0.095); aortic atheroma (p = 0.066); and any source of embolism from heart (p = 0.007). Any source of embolism from heart was the only factor which significantly enhanced the risk of stroke recurrence (p = 0.015). Using Kaplan-Meier life table analysis, the curves of percent free of recurrent stroke were significantly different (log rank test p = 0.002). Conclusions: Until the mechanism of lacunar stroke is better understood, it is reasonable to suggest that its investigation and prevention should be directed at all potential causes of future strokes including cardioembolism.

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“…Subsequent evidence about the relatively low risk of cerebral thromboembolism among patients with a patent foramen ovale or mitral valve prolapse supports the original decision to require evidence of absence of other potential causes of stroke before the vascular event could be attributed to these lesions. 9,10 There are limitations and criticisms of the TOAST classification. It was not designed for use in making stroke subtype diagnoses in children.…”

Section: History Of the Trial Of Org 10 172 In Acute Stroke Treatmentmentioning

confidence: 99%

Classification of Subtypes of Ischemic Stroke

Adams

Biller

2015

Stroke

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Risk of Stroke With Mitral Valve Prolapse in Population-Based Cohort Study

Abstract: Individuals with uncomplicated mitral valve prolapse did not have an increased risk of stroke, although a small increase in the risk may not have been detected.

Cited by 54 publications

References 36 publications

Role of routine transthoracic echocardiography in evaluation and management of stroke

Role of routine transthoracic echocardiography in evaluation and management of stroke

Lacunar Stroke: Transoesophageal Echocardiographic Factors Influencing Long-Term Prognosis

Classification of Subtypes of Ischemic Stroke

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