Page 13 - Journal of Structural Heart Disease Volume 5, Issue 5

Original Scientific Article
Journal of Structural Heart Disease, October 2019, Volume 5, Issue 5:206-212
DOI: https://doi.org/10.12945/j.jshd.2019.034.18
Received: October 01, 2018 Accepted: October 18, 2018 Published online: October 2019
Difference Among Embolic Sources Between Younger and Older Patients with Stroke of Undetermined Source on Routine Diagnostic Assessment Including Transesophageal Echocardiography
Hiroya Takafuji, MD*, Shinobu Hosokawa, MD, Riyo Ogura, MD, Yoshikazu Hiasa, MD Department of Cardiology, Tokushima Red Cross Hospital, Komatsushima, Tokushima, Japan
Abstract
Background: The distribution of embolic sources in patients with embolic stroke of undetermined source (ESUS) remains unclear. Furthermore, the difference among embolic sources according to age is unknown. The aim of this study was to identify the distribution of embolic sources in younger and older patients with embolic strokes who underwent routine diagnostic assessment with transesophageal echocardiography (TEE) and to evaluate the distribution of paradoxical embolism related to patent foramen ovale (PFO) be- tween younger and older.
Methods and Results: Between May 2012 and December 2017, 102 ESUS patients underwent routine diagnostic assessment including TEE at our hospital to identify the specific cause of their embolic stroke. We compared the causes of embolic stroke between younger (<60 years; mean age, 49.3 ± 10.9 years; n=24) and older (>60 years; mean age, 74.8 ± 6.2 years; n=78) patients. Old- er patients had significantly higher rates of aortic arch atherosclerotic plaques (4.2% vs. 48.7%; p <0.001). The other causes were not significantly different between the two groups. Especially in paradoxical embolism related to PFO, younger patients had fewer other em- bolic sources in addition to PFO or both PFO and atrial septal aneurysm (ASA) than older patients. However,
older patients also exhibited PFO or both PFO and ASA (32.6%) without other embolic sources.
Conclusions: Our study suggests that embolic source of ESUS to undergo routine diagnostic assessment in- cluding transesophageal echocardiography (TEE) is similar between younger and older. However, the total numbers of embolic sources is significantly higher in older patients. In paradoxical embolism related to PFO, 33% of older patients had no other identifiable cause of embolic stroke besides a PFO.
Copyright © 2019 Science International Corp.
Key Words
Embolic stroke of undetermined source • Age • Patent foramen ovale
Introduction
Embolic stroke of undetermined source (ESUS) is a form of stroke defined based on a set of criteria pro- posed by the Cryptogenic Strokes/ESUS Internation- al Working Group [1]. Although the causes of ESUS have been previously reported in multiple studies, the cause of stroke could not be identified using the ESUS criteria in a number of patients. Moreover, this
* Corresponding Author:
Hiroya Takafuji, MD
Department of Cardiology
Tokushima Red Cross Hospital
103 Irinokuchi, Komatsushima-cho, Komatsushima, Tokushima 773-8502, Japan
Tel. +81 885 32 2555; Fax: +81 885 32 6350; E-Mail: takafuji@tokushima-med.jrc.or.jp
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2019 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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