Published online before print January 22, 2004, doi: 10.1161/01.STR.0000115531.90888.A4
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(Stroke. 2004;35:e24.)
© 2004 American Heart Association, Inc.
Letters to the Editor |
Stroke in China
Division of Cardiology, George Washington University Medical Center, Washington, DC
To the Editor:
I read with interest the important article on proportion of different subtypes of stroke in China.1 However, it was unclear to me if stroke due to paradoxical embolism was included or excluded in the study. Because paradoxical embolism is a frequent cause of stroke in the young2,3 and because paradoxical embolism is nowadays a preventable disease,3,4 the knowledge of its frequency in China is extremely important "to provide a scientific base for making an appropriate stroke prevention strategy in the most populous country in the world."1
Paradoxical embolism refers to arterial embolization of a venous thrombus via a patent foramen ovale, atrial septal defect, or fenestrated atrial septal aneurysm.2–7 It is easily diagnosable nowadays by contrast echocardiography.2,8–16 In a recent report published in the same issue of Stroke, a patent foramen ovale, atrial septal aneurysm, the Eustachian valve and right atrial filamentous strands, all of which favor paradoxical embolism, are significantly more prevalent among whites and Hispanics than blacks.17 Thus, such an ethnic difference renders the recognition of their frequency among the Chinese of even greater significance as an important risk factor for stroke in China.
References
1. Zhang L-F, Yang J, Hong Z, Yuan G-G, Zhou B-F, Zhao L-C, Huang Y-N, Chen J, Wu Y-F, for the Collaborative Group of China Multicenter Study of Cardiovascular Epidemiology. Proportion of different subtypes of stroke in China. Stroke. 2003; 34: 2091–2096.
2. Cheng TO. Predisposing factors in cardiogenic cerebral embolism. Stroke. 1990; 21: 1643.Letter.
3. Cheng TO. Percutaneous closure of patent foramen ovale is the procedure of choice for paradoxical embolism. Circulation. 2003; 108: e126.Letter.[Medline] [Order article via Infotrieve]
4. Cheng TO. Paradoxical embolism: diagnosis and management. J Emerg Med. 2001; 20: 416–417.[CrossRef][Medline] [Order article via Infotrieve]
5. Cheng TO. Paradoxical embolism: a diagnostic challenge and its detection during life. Circulation. 1976; 53: 565–568.
6. Cheng TO. Paradoxic embolism. Am Heart J. 1996; 131: 1238.Letter.
7. Cheng TO. Impending paradoxical embolism. Arch Intern Med. 1998; 158: 1720.Letter.
8. Cheng TO. Echocardiography and paradoxical embolism. Ann Intern Med. 1981; 95: 515.Letter.[CrossRef][Medline] [Order article via Infotrieve]
9. Cheng TO. Impending paradoxical embolism. Eur Heart J. 1995; 16: 292.Letter.
10. Cheng TO. Paradoxical emboli after pulmonary embolus. Presse Med. 1995; 24: 1049.Letter.
11. Cheng TO. Impending paradoxical embolism: a transesophageal echocardiographic image. Clin Cardiol. 1999; 22: 328.Letter.[Medline] [Order article via Infotrieve]
12. Cheng TO. Echocardiography in ischaemic cerebrovascular disease. BMJ. 1987; 295: 856.Letter.
13. Cheng TO. Paradoxical embolism. Postgrad Med. 1988; 84 (3): 29.Letter.
14. Cheng TO. Patent foramen ovale in elderly stroke patients. Postgrad Med J. 1991; 67: 1083.Letter.
15. Cheng TO. Diagnosis of paradoxic embolism. Int J Cardiol. 1998; 66: 223.Letter.[CrossRef][Medline] [Order article via Infotrieve]
16. Cheng TO. Pulmonary embolism and impending paradoxical embolism: a role for echocardiography? Clin Cardiol. 1998; 21: 611.Letter.[Medline] [Order article via Infotrieve]
17. Rodriguez CJ, Homma S, Sacco RL, Di Tullio MR, Sciacca RR, Mohr JP, for PICSS Investigators. Race-ethnic differences in patent foramen ovale, atrial septal aneurysm, and right atrial anatomy among ischemic stroke patients. Stroke. 2003; 34: 2097–2102.
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