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(Stroke. 1997;28:1574-1578.)
© 1997 American Heart Association, Inc.

Articles

Mitral Valve Strands and the Risk of Ischemic Stroke in Elderly Patients

Ariel Cohen, MD, PhD; Christophe Tzourio, MD, PhD; Christophe Chauvel, MD; Bernard Bertrand, MD; Isabelle Crassard, MD; Yvette Bernard, MD; Luc Goullard, MD; Sylvie Falcon, MD; Marie-Germaine Bousser, MD; Pierre Amarenco, MD for the French Study of Aortic Plaques in Stroke (FAPS) Investigators

From the Service de Cardiologie (A.C., C.C.) and Neurologie (C.T., I.C., M-G.B., P.A.), Hôpital Saint-Antoine, Université Pierre et Marie Curie, Paris; INSERM U 360 Recherches épidémiologiques en Neurologie et Psychopathologie, Hôpital de la Pitié-Salpétrière (C.T.), Paris; and the Cliniques Cardiologiques des Centres Hospitaliers Universitaires de Grenoble (B.B.), Besançon (Y.B.), Lille (L.G.), and Dijon (S.F.), France.

Correspondence to Ariel Cohen, MD, PhD, Service de Cardiologie, Hôpital Saint-Antoine, Université Pierre et Marie Curie, 184, rue du faubourg St-Antoine, 75571 Paris, Cedex 12, France. E-mail ariel.cohen{at}sat.ap-hp-paris.fr

Background and Purpose Strands are thin and filamentous attachments on the cardiac valves shown by transesophageal echocardiography. Their nature and their potential for embolization are largely unknown. The objective was to estimate the risk of brain infarction in patients with mitral valve strands.

Methods Using transesophageal echocardiography, we compared the frequency of strands on native mitral valves in 284 consecutive patients admitted with brain infarction and 276 control patients, all older than 60 years. In a second part, case subjects were followed up over a 2- to 4-year period, and the risk of recurrence of brain infarction was estimated in patients with and without strands.

Results In the case-control study, mitral valve strands were found in 22.5% of the case patients and in 12.1% of the control subjects. In case subjects, mitral valve strands were more frequent in those with mitral valve dystrophy (52.4% versus 37.4%; P=.03). Strands were not associated with mitral valve prolapse, annular calcifications, or left atrial spontaneous echocardiographic contrast. After adjustment for age, sex, and mitral valve dystrophy, the odds ratio for ischemic stroke among patients with mitral strands was 2.2 (95% confidence interval, 1.4 to 3.6; P=.005). The frequency of strands was not different in patients with a known cause of brain infarction (24.4%) from that in patients with no other apparent cause (20.9%). During 646 per 100 person-years of follow-up, the incidence of recurrent brain infarction was 6.0 person-years in patients with strands and 4.2 in those without. In the Cox analysis, including potential confounders and poststroke treatment, mitral valve strands did not appear as independent predictors of recurrent brain infarction (relative risk, 1.3; 95% confidence interval, 0.5 to 3.0; P=.54).

Conclusions The present study shows an independent association between mitral valve strands and the risk of brain infarction. However, the lack of an increased relative risk of recurrence raises doubts about the potential causal relation with brain infarction in patients aged 60 years or older.

Key Words: cardioembolic stroke • cerebral infarction • mitral valve • transesophageal echocardiography

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