Stroke, Vol 24, 1865-1873, Copyright © 1993 by American Heart Association
L Cabanes, JL Mas, A Cohen, P Amarenco, PA Cabanes, P Oubary, F Chedru, F Guerin, MG Bousser and J de Recondo
BACKGROUND AND PURPOSE: An association between atrial septal aneurysm and
embolic events has been suggested. Atrial septal aneurysm has been shown to
be associated with patent foramen ovale and, in some reports, with mitral
valve prolapse. These two latter cardiac disorders have been identified as
potential risk factors for ischemic stroke. The aim of this prospective
study was to assess the role of atrial septal aneurysm as an independent
risk factor for stroke, especially for cryptogenic stroke. METHODS: We
studied the prevalence of atrial septal aneurysm, patent foramen ovale, and
mitral valve prolapse in 100 consecutive patients < 55 years of age with
ischemic stroke who underwent extensive etiological investigations. We
compared these results with those in a control group of 50 consecutive
patients. The diagnosis of atrial septal aneurysm and patent foramen ovale
relied on transesophageal echocardiography with a contrast study and that
of mitral valve prolapse, on two-dimensional transthoracic
echocardiography. RESULTS: Stepwise logistic regression analysis showed
that atrial septal aneurysm (odds ratio, 4.3; 95% confidence interval, 1.3
to 14.6; P = .01) and patent foramen ovale (odds ratio, 3.9; 95% confidence
interval, 1.5 to 10; P = .003) but not mitral valve prolapse were
significantly associated with the diagnosis of cryptogenic stroke. The
stroke odds of a patient with both atrial septal aneurysm and patent
foramen ovale were 33.3 times (95% confidence interval, 4.1 to 270) the
stroke odds of a patient with neither of these cardiac disorders. For a
patient with atrial septal aneurysm of > 10-mm excursion, the stroke
odds were approximately 8 times the stroke odds of a patient with atrial
septal aneurysm of < 10 mm. CONCLUSIONS: This study shows that atrial
septal aneurysm and patent foramen ovale are both significantly associated
with cryptogenic stroke and that their association has a marked synergistic
effect. Atrial septal aneurysms of > 10-mm excursion are associated with
a higher risk of stroke.
ARTICLES
Atrial septal aneurysm and patent foramen ovale as risk factors for cryptogenic stroke in patients less than 55 years of age. A study using transesophageal echocardiography
Service de Cardiologie, Hopital Cochin, Paris, France.
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