Copyright © 1996 by the European Society of Cardiology.
© 1996 The European Society of Cardiology
Potential cardioembolic sources of stroke in patients less than 60 years of age
*Service de Neurologie et d'urgences cérébrovasculaires, Pr Paul Trouilas
Laboratoire d'echocardiographie-Doppler, hôpital cardiologique Lyon
Laboratoire d'informatique médicale UFR Alexis Carrel
Received 29 May 1995; accepted 2 August 1995.
Correspondence: Dr Nighoghossian, service de Neurologie du Pr Trouillas (urgences neurovasculaires et centre de recherches sur l'ataxie), Hôpital neurotogique, 59 Bd Pinel 69003, Lyon, France
Abstract
Minor potential cardioembolic sources of stroke such as atrial septal aneurysm or patent foramen ovale are important risk factors for cryptogenic stroke. We aimed to determine the prevalence of these abnormalities through an exhaustive aetiological work-up. One hundred and eighteen stroke patients under 60 years of age, who had no evidence of a significant cardiac source of embolism, were classified into four groups following transoesophageal echocardiography and assessment of cervical arteries. Group A comprised 30 patients (25·4%) who had an arteriopathy, probably related to stroke without any cardiac abnormality; group B, had only a potential cardiac source; group C, nine (7·6% had an obvious arterial source of stroke and incidental cardiac abnormalities; group D, 30 (25·4%) had neither cardiac or arterial source.
Data were analysed with the Chi-square test to compare risk factors between groups, and variance analysis was used to compare age between groups. Significance was assessed as P<0·05 Fisher's exact test was used to test the association between arterial septal aneurysm and patent foramen ovale.
In groups B and D atrial septal aneurysm represented 56 of the cardiac abnormalities and was diagnosed in 35·4% of the 79 patients who had an unexplained stroke, and a patent foramen ovate was found in 34·1% of the patients. According to Fisher's exact test, atrial septal aneurysm was significantly associated with patent foramen ovale (P<<0·001 On this basis, one fourth of the patients might be said to have had a truly cryptogenic stroke as the aetiological work-up failed to demonstrate any source of stroke. Comparison between groups showed that in 23% of the patients in whom an arterial source was detected, there was also a potential cardioembolic source (group C), vs 62% in patients who had no arterial source (groups B and D) (p=0·0007). Our study confirmed the strong association between atrial septal aneurysm, patent foramen ovate and stroke. Although there was a lower incidence of cardiac risk factors for stroke in patients who had cervical artery disease, we suggest that all patients who have a stroke without evidence of a major cardiac source should undergo transoesophageal echocardiography, in order to ensure a better prevention.
Key Words: Atrial septal aneurysm • patent foramen ovale • cryptogenic stroke • transoesophageal echocardiography
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