Page 15 - Journal of Structural Heart Disease Volume 5, Issue 5

Original Scientific Article
208
Table 1. Patient characteristics according to age
wore off. Atrial septal aneurysms (ASAs) were defined as an interatrial septum with a 10 mm protrusion into the right or left atrium and a diameter ≥15 mm at the base of the aneurysm. Reduced left atrial appendage blood flow (LAAF) was defined as <30 cm/sec. Aor- tic plaque was defined as plaque thickness >4 mm in the aortic arch or descending aorta. The total num- ber of embolic sources was used to calculate the risk of stroke according to the ESUS criteria for embolic stroke [1].
Statistical analysis
Continuous variables are expressed as mean ± standard deviation. Categorical variables were com- pared between groups using the chi-squared or Fish- er’s exact tests. A p <0.05 was considered statistically significant. All data were analyzed using JMP version 8 (SAS Institute, Cary, NC).
Ethical approval
This present study has been approved by ethics standards of the institutional research, and the study was performed in accordance with the 1964 Declara- tion of Helsinki.
Results
Baseline characteristics
The baseline characteristics of the younger and older patients are shown in Table 1.The mean age of patients in this study was 68.8 ± 13.2 years and 71 (69.9%) were male. Compared with the younger pa- tients, the rates of hypertension were significantly higher in the older patients. The prevalence of diabe- tes mellitus, dyslipidemia, smoking history, and pre- vious stroke were similar between the younger and older patients. None of the patients in either group had a history of atrial fibrillation or flutter.
Distribution of embolic sources in patients with ESUS according to age
The various embolic sources are summarized in Table 2. The most frequent cause of embolic stroke was PFO (56.9%), followed by aortic arch athero- sclerotic plaques (38.2%). No significant differences between the groups were found in the rates of mi- nor-risk potential cardio embolic sources such as the
All patients (n=102)
Younger (n=24)
Older (n=78)
P value
Age, yrs
Body mass index, kg/m2
Male Hypertension Diabetes mellitus Dyslipidemia Smoking history Previous stroke Af history
68.8±13.2 23.1±3.1
71(69.6) 64(62.7) 27(26.5) 62(60.1) 53(51.9) 18(17.6) 0(0)
49.3±10.9 23.8±3.4
17(70.8) 7(29.2) 7(29.2) 15(62.5) 15(62.5) 3(12.5) 0(0)
74.8±6.2 <0.001 22.9±3.0 0.21
54(69.2) 0.88 57(73.1) <0.001 20(25.6) 0.73 47(60.3) 0.84 38(48.7) 0.24 15(19.2) 0.45
0(0) -
Values are mean±SD, n (%). Af: atrial fibrillation
nostic criteria and were classified according to the cause of embolic stroke [1]. Based on joint decision by a neurologist and cardiologist, 102 patients under- went routine diagnostic assessment with additional TEE to determine the specific cause of their embolic stroke. Patients who were unstable or did not provide consent were excluded. Moreover, we compared the cause of embolic stroke between younger (≤60 years; mean age, 49.3 ± 10.9 years; age range, 23–60 years; n=24) and older (>60 years; mean age, 74.8 ± 6.2 years; age range, 62–86 years; n=78) patients.
TEE examination and definitions of cardiac sources of embolism
TEE was performed to determine the specific em- bolic source, in addition to routine diagnostic as- sessment. An IE33 echocardiography system (Philips Medical Systems, Eindhoven, The Netherlands) with a multiplane transesophageal 5-MHz transducer was used. TEE was performed under sedation, and em- bolic sources were diagnosed by consensus of two experienced echocardiography specialists. PFO was defined as the presence of a right-to-left shunt using agitated saline contrast microbubbles within three cardiac cycles via a Valsalva maneuver with abdom- inal compression after complete opacification of the right atrium. TEE for detection of PFO was performed at the end of the examination after the anesthetic
Journal of Structural Heart Disease, October 2019
Volume 5, Issue 5:206-212