Abstract WP223: Factors Influencing Recurrent Stroke: TEE Study With Longitudinal Observation in Cryptogenic Stroke
Background: Transesophageal echocardiography (TEE) has been critical for investigating cryptogenic stroke (CS) after routine stroke evaluation fails to identify the etiologies of ischemic stroke, to examine potential embolic sources. So far, little information on the long-term outcome in CS patients has been available. This study sought to investigate the clinical characteristics and diverse embolic etiologies on TEE related to stroke recurrence in CS patients.
Methods: From April 2008 to March 2014, stroke patients who were categorized to CS using the criteria of the Trial of Org 10172 in Acute Stroke Treatment after routine stroke examinations, and underwent TEE were included in this single-center observational study. Clinical characteristics, laboratory and MRI findings, and embolic etiologies on TEE were investigated. Follow-up data were obtained by reviewing medical records and survey questionnaires. Survey questionnaires were carried out in the out patient department, mailed to patients or families, or by telephone. The questionnaire included recurrence of ischemic stroke, cardiovascular events, and death that occurred since discharge from our hospital, and information of medical history.
Results: A total of 175 patients (age, 64.0 ± 12 years; 127 males) with CS patients were enrolled. 25 patients had recurrent stroke (RS) and 5 had cardiovascular events, and 7 died. The RS group had higher frequency of diabetes mellitus (DM), multiple infarcts on diffusion-weighted image (DWI), and atheromatous aortic plaques ≥ 4 mm, and higher levels of serum glucose and C-reactive protein on admission (P<0.05, respectively). CAM score that was previously defined as consisting of the degree of calcification in the aortic arch (0-3 points), age (≥70 years: 1 point), and DWI findings (multiple infarctions in 1 vascular territory, VT: 1 point; 2 VTs: 2 points; more than 3 VTs: 3 points) was also higher in the RS group (P<0.05). Cox regression analysis showed that DM (HR: 2.76; 95% CI: 1.23 to 6.22; P=0.014) and the CAM score ≥ 3 points (OR: 3.02; 95% CI: 1.32 to 6.93; P=0.009) were associated with RS.
Conclusions: DM and the CAM score but not embolic etiologies and treatments were associated with higher risk of recurrence in CS.
Author Disclosures: Y. Ueno: None. K. Yamashiro: None. R. Tanaka: None. T. Kuroki: None. K. Hira: None. N. Kurita: None. T. Urabe: None. N. Hattori: None.
- © 2016 by American Heart Association, Inc.