Konstantinos Spengos1, Konstantinos N Vemmos. 1. Department of Neurology, University of Athens School of Medicine, Eginition Hospital, Athens, Greece. Spengos@hol.gr
Abstract
INTRODUCTION: Cardioembolism is the most frequent cause of ischemic stroke in Greece. However, data regarding this stroke subtype in young adults from Greece and the East Mediterranean area are scarce. METHODS: We aimed to determine the source of embolism and evaluate outcomes in a sample of young Greek patients with ischemic stroke of cardioembolic etiology. A series of 245 Greek patients with ischemic stroke at an age up to 45 years were selected from a consecutive series of 2820 first-ever stroke patients admitted to our departments during the period January 1998 to December 2008. RESULTS: Cardioembolism was diagnosed in 45 cases (18.4%). Almost half of the cases (48.9%) were attributed to congenital anomalies of the interatrial septum, including 13 cases of patent foramen ovale (28.9%), 7 cases of atrial septum aneurysm (15.6%), and 1 case with both defects (2.2%). The majority of strokes in our young patient collective were related to medium-risk sources of embolism, while high-risk sources, namely dilated cardiomyopathy, atrial fibrillation and akinetic left ventricular lesions, were found in only 33.3%. The overall probability of 10-year survival was 89.4% (95% confidence interval 79.4-99.4), whereas the probability of a new composite vascular event was 14.3% (95% confidence interval 2.3-26.3) during the same period. The clinical outcome in general was excellent, since the majority of patients (82.2%) showed no significant handicap on follow up. CONCLUSIONS: As in other western countries, it would seem that atrioseptal abnormalities played an important role as a cause of cardioembolism in this young Greek population, whereas atrial fibrillation and other major cardioembolic sources seem to be of minor relevance as compared to stroke in elderly patients.
INTRODUCTION: Cardioembolism is the most frequent cause of ischemic stroke in Greece. However, data regarding this stroke subtype in young adults from Greece and the East Mediterranean area are scarce. METHODS: We aimed to determine the source of embolism and evaluate outcomes in a sample of young Greek patients with ischemic stroke of cardioembolic etiology. A series of 245 Greek patients with ischemic stroke at an age up to 45 years were selected from a consecutive series of 2820 first-ever strokepatients admitted to our departments during the period January 1998 to December 2008. RESULTS: Cardioembolism was diagnosed in 45 cases (18.4%). Almost half of the cases (48.9%) were attributed to congenital anomalies of the interatrial septum, including 13 cases of patent foramen ovale (28.9%), 7 cases of atrial septum aneurysm (15.6%), and 1 case with both defects (2.2%). The majority of strokes in our young patient collective were related to medium-risk sources of embolism, while high-risk sources, namely dilated cardiomyopathy, atrial fibrillation and akinetic left ventricular lesions, were found in only 33.3%. The overall probability of 10-year survival was 89.4% (95% confidence interval 79.4-99.4), whereas the probability of a new composite vascular event was 14.3% (95% confidence interval 2.3-26.3) during the same period. The clinical outcome in general was excellent, since the majority of patients (82.2%) showed no significant handicap on follow up. CONCLUSIONS: As in other western countries, it would seem that atrioseptal abnormalities played an important role as a cause of cardioembolism in this young Greek population, whereas atrial fibrillation and other major cardioembolic sources seem to be of minor relevance as compared to stroke in elderly patients.
Authors: Noortje A M M Maaijwee; Loes C A Rutten-Jacobs; Pauline Schaapsmeerders; Ewoud J van Dijk; Frank-Erik de Leeuw Journal: Nat Rev Neurol Date: 2014-04-29 Impact factor: 42.937