1
|
Hutyra M, Sanak D, Kral M, Dornak T, Precek J, Hudec S, Navratil K, Kocianova E, Koubek F, Kanovsky P, Taborsky M. Transoesophageal echocardiography findings in young patients with cryptogenic ischemic stroke. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and purpose
The cause of ischemic stroke (IS) remains often unclear in young patients. Relevant structural heart abnormities with known embolic potential may represent cause of IS also in young population. The use of transoesophageal echocardiography (TEE) allows reliable detection of most relevant structural pathologies. The aim was to assess frequency and spectrum of relevant cardiac abnormities in young IS patients.
Subjects and methods
The study set consisted of young acute IS patients <50 years enrolled in the prospective HISTORY (Heart and Ischemic STrOke Relationship studY) study, registered on ClinicalTrials.gov NCT01541163). In all patients, the brain ischemia was confirmed on CT or MRI. Admission ECG, serum specific cardiac markers, TEE, 24-hour and 3-week ECG-Holter were performed in all patients.
Results
Out of 1284 patients enrolled in the HISTORY study, 135 (73 males, mean age 40.2±8.1 years) were <40 years. In total, the relevant TEE abnormities were present in 47 (35%) of these patients. Patent foramen ovale (PFO) with evident left to right shunt was detected in 38 (28%) patients, with significant right to left shunt in 25 (19%) patients, and other atrial septal defect with clinically significant bidirectional flow in 4 (3%) patients. Significant valvular heart disease was present in 2 (1%) patients (1 bicuspid aortic valve with moderate aortic regurgitation, 1 chronic severe mitral regurgitation), and 4 (3%) patients severe left ventricular systolic dysfunction (left ventricular ejection fraction ≤35%) due to idiopathic dilated cardiomyopathy. Left atrial myxoma was detected in one patient.
Conclusion
The relevant structural abnormities with embolic potential were detected using TEE in 35% of young IS patients. Routine use of TEE to elucidate the causes of stroke, has a role especially in young patients who present with cryptogenic stroke and no cardiovascular risk factors, as well as in the setting of a PFO associated with a deep venous thrombosis.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): IGA LF UP, MH CZ - DRO
Collapse
Affiliation(s)
- M Hutyra
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology , Olomouc , Czechia
| | - D Sanak
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology , Olomouc , Czechia
| | - M Kral
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology , Olomouc , Czechia
| | - T Dornak
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology , Olomouc , Czechia
| | - J Precek
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology , Olomouc , Czechia
| | - S Hudec
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology , Olomouc , Czechia
| | - K Navratil
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology , Olomouc , Czechia
| | - E Kocianova
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology , Olomouc , Czechia
| | - F Koubek
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology , Olomouc , Czechia
| | - P Kanovsky
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology , Olomouc , Czechia
| | - M Taborsky
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology , Olomouc , Czechia
| |
Collapse
|
2
|
Sanak D, Divisova P, Hutyra M, Kral M, Bartkova A, Latal J, Zapletalova J, Veverka T, Hudec S, Franc D, Dornak T, Kanovsky P. Risk of recurrent ischemic stroke in young cryptogenic patients with embolic stroke of undetermined source. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
3
|
Cerník D, Sanak D, Divisova P, Köcher M, Cihlar F, Zapletalova J, Veverka T, Ospalik D, Cerna M, Janousova P, Belinova K, Kral M, Dornak T, Franc D, Prasil V, Kanovsky P. Levels of glycemia within the first 48 hours after mechanical thrombectomy for acute ischemic stroke may affect clinical outcome. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
4
|
Hutyra M, Sanak D, Kral M, Veverka T, Dornak T, Divisova P, Precek J, Spacek M, Latal J, Kanovsky P, Taborsky M. P3709Risk of recurrent cerebral ischemia in young patients with cryptogenic ischemic stroke and patent foramen ovale. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The cause of ischemic stroke (IS) remains often unclear in young patients. Relevant structural heart abnormities with known embolic potential may represent cause of IS also in young population. A persistent foramen ovale (PFO) is a known risk factor for paradoxical embolism, including ischemic stroke (IS).
Aims
The aims of our prospective study were to assess the rates of recurrent ischemic stroke events in young IS patients with PFO during a 35-month follow-up period (FUP) on effective antiplatelet therapy (OAT) and to evaluate a potential relationship with the presence of PFO on transesophageal echocardiography (TEE).
Methods
The study set consisted of young acute IS patients <50 years enrolled in the prospective HISTORY (Heart and Ischemic STrOke Relationship studY) study, NCT01541163). In all patients, the brain ischemia was confirmed on CT or MRI. Admission ECG, serum specific cardiac markers, transesophageal echocardiography, 24-hour and 3-week ECG-Holter were performed in all patients.
Results
Out of 980 patients enrolled in the HISTORY study, 260 patients were younger than 50 years and 185 (56% males, mean age 41±8 years) patients were classified as cryptogenic IS in ASCOD classification. PFO was diagnosed in 60 patients (32%). Six new clinically apparent recurrent ischemic brain events were recorded during a 35-month FUP. No significant difference was found in the presence of IS recurrence between patient group with PFO and without PFO (2 [3.2% patients with PFO] versus 4 [3.2% without PFO] of young IS patients, P=0.99).
Conclusion
The presence of PFO was not associated with a higher risk of new brain ischemic lesions in young patients with with cryptogenic ischemic stroke during a 35-month follow-up period. Number of recurrent clinical IS is relatively small, thus achieved results may be not so robust.
Acknowledgement/Funding
Grant support IGA MZ CR NT/14288-3, AZV MZ CR 17-30101A, IGA LF UP Olomouc (2016-2018), FNOL SUG No. 87-85
Collapse
Affiliation(s)
- M Hutyra
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology, Olomouc, Czechia
| | - D Sanak
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology, Olomouc, Czechia
| | - M Kral
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology, Olomouc, Czechia
| | - T Veverka
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology, Olomouc, Czechia
| | - T Dornak
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology, Olomouc, Czechia
| | - P Divisova
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology, Olomouc, Czechia
| | - J Precek
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology, Olomouc, Czechia
| | - M Spacek
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology, Olomouc, Czechia
| | - J Latal
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology, Olomouc, Czechia
| | - P Kanovsky
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology, Olomouc, Czechia
| | - M Taborsky
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology, Olomouc, Czechia
| |
Collapse
|
5
|
Kanovsky P, Dornak T, Justanova M, Jech R, Bares M, Dusek L, Hoskovcova M, Riha M, Navratilova D, Otruba P. Epidemiology of spastic dystonia in stroke patients – Pilot results of sonar study. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.1059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
6
|
Sanak D, Hutyra M, Kral M, Precek J, Divisova P, Veverka T, Dornak T, Latal J, Franc D, Bartkova A, Taborsky M, Kanovsky P. Relevant structural and functional heart abnormities in young ischemic stroke patients: Tee findings from the history study. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
7
|
Sanak D, Kral M, Hutyra M, Veverka T, Dornak T, Vindis D, Bartkova A, Skoloudik D, Taborsky M, Kanovsky P. Cardioembolic etiology of acute ischemic stroke in patients indicated to revascularization. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.1444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|