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(Stroke. 1997;28:2185-2188.)
© 1997 American Heart Association, Inc.

Articles

Valvular Strands and Cerebral Ischemia

Effect of Demographics and Strand Characteristics

J. Kirk Roberts, MD; Iqbal Omarali, MD; Marco R. Di Tullio, MD; Robert R. Sciacca, EngScD; Ralph L. Sacco, MD, MS; Shunichi Homma, MD

From the Department of Neurology (J.K.R., R.L.S.), School of Public Health–Epidemiology (R.L.S.), Sergievsky Center (J.K.R., R.L.S.), and Division of Cardiology, Department of Medicine (I.O., M.R. Di T., R.R.S., S.H.), Columbia–Presbyterian Medical Center, New York, NY.

Correspondence to Shunichi Homma, MD, Division of Cardiology, PH3-342, Columbia–Presbyterian Medical Center, 622 W 168th St, New York, NY 10032. E-mail hommash{at}medicine1.cpmc.columbia.edu

Background and Purpose Valvular strands, thin filamentous material attached to the mitral or aortic valve, are seen during transesophageal echocardiography and have been associated with stroke. Little is known about this association in different age, sex, and race-ethnic subgroups and the effect of various strand characteristics on this association.

Methods From patients referred for transesophageal echocardiography, 73 patients with recent ischemic stroke (68) or transient ischemic attack (5) were age matched to 73 stroke- and transient ischemic attack–free control subjects. The association between valvular strands and cerebral ischemia was evaluated for the overall group and demographic subgroups. The effect of strand location, length, number, and valve thickness was also determined.

Results An association between cerebral ischemia and valvular strands was observed (odds ratio [OR]=4.4; 95% confidence interval [CI]=2.0 to 9.6). The association was found for both men and women and among all three race-ethnic groups. The OR was greater in those who were younger (12.5 [95% CI=2.4 to 64.5] for age <60, 4.8 [95% CI=1.3 to 18.2] for age 60 to 69, and 1.8 [95% CI=0.5 to 6.4] for age 70 years). Strands on both the mitral (OR=3.5; 95% CI=1.5 to 7.9) and aortic (OR=3.7; 95% CI=1.1 to 11.9) valve were associated with cerebral ischemia, whereas the number and length of strands were not. The effect of strands was independent of mitral or aortic valve thickness.

Conclusions Valvular strands, whether mitral or aortic, are associated with ischemic stroke, especially among younger persons.

Key Words: cardiovascular disorders • cerebral ischemia • risk factors • young adults

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