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- Title
Risk of Recurrent Neurologic Stroke or Transient Ischemic Attack in Patients with Cryptogenic Stroke and Intrapulmonary Shunt.
- Authors
Sinha, Rahul S.; Hussain, Zeeshan; Bhatia, Nirmanmoh; Stoddard, Marcus F.
- Abstract
Background and Purpose Cardio-embolic phenomenon is believed to underlie a significant proportion of cryptogenic strokes. We recently showed that intrapulmonary shunt ( IPS) was associated with cryptogenic stroke and transient ischemic attack ( TIA). We hypothesized that patients with prior cryptogenic stroke or TIA that had an IPS were at a higher risk for recurrent ischemic events. Methods The population included subjects with cryptogenic cerebrovascular accident ( CVA) or TIA. Inclusion criteria were age ≥18 years, sinus rhythm, and clinically indicated transesophageal echocardiography ( TEE). Exclusion criteria were hemorrhagic CVA, septal defect, and patent foramen. Patients were followed from index TEE. Results Of 71 patients, 8 were lost to follow-up. A total of 23 patients had and 40 were without IPS. Average follow-up duration was 38.3 ± 19.2 months. Groups were similar at baseline. There was no significant difference in the recurrence of ischemic CVA or TIA in the IPS versus non- IPS groups (0% vs. 7.5%; P = NS). There was no difference between the incidence of hemorrhagic CVA in the IPS and non- IPS groups (4.3% vs. 5.0%; P = NS). The proportion of patients on warfarin in the IPS group was significantly higher compared to the non- IPS group (17.4% vs. 0%; P < 0.05). Conclusions Patients with IPS and cryptogenic stroke or TIA did not have a higher recurrence of ischemic cerebral events. Warfarin was significantly higher at follow-up in the IPS compared to the non- IPS group, which may explain these findings. A study randomizing patients with IPS and cryptogenic stroke or TIA to warfarin or no warfarin would be of great interest.
- Subjects
STATISTICAL correlation; FISHER exact test; STROKE; T-test (Statistics); TRANSESOPHAGEAL echocardiography; TRANSIENT ischemic attack; DATA analysis software; DESCRIPTIVE statistics; KAPLAN-Meier estimator
- Publication
Echocardiography, 2016, Vol 33, Issue 2, p276
- ISSN
0742-2822
- Publication type
Article
- DOI
10.1111/echo.13017