Department of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, I.R. Iran
Background: The relative importance of different risk factors of stroke may vary between various etiologies and countries. We sought to describe the cardiac risk factors of ischemic cerebral infarction in a university hospital in Tehran, Iran.
Methods: This prospective, observational study was carried out on 58 consecutive patients admitted to the neurology ward of Baharloo Hospital in Tehran, Iran, with a diagnosis of established ischemic stroke or transient ischemic attack. Data regarding each patient’s demographic profile, clinical presentation, medical history (emphasis on risk factors), results of brain imaging, biochemical profile, and other diagnostic tests were recorded in a structured form. Diagnostic neurological studies comprised computed tomography scan of the head and brain, brain magnetic resonance imaging in selected patients, and Doppler ultrasonography of carotid arteries. Cardiologic studies consisted of standard 12-lead ECG, 24-hour Holter monitoring, and 2D transesophageal echocardiography (TEE) obtained over a 7-day period after the onset of symptoms. The recorded data were statistically analyzed for the percent- age, mean, and standard deviation of all the variables. SPSS, version 22.0, for Windows was used for all the statistical analyses.
Results: Atrial fibrillation was evident in respectively 6.9% and 15.5% of the ECGs and Holter monitoring cardiograms. The echocardiographic findings of our studied subjects are depicted in detail in Table 2. The most prevalent finding was aortic valve stenosis or calcification in 70.7% of the subjects, followed by aortic arch wall calcification in 55.2%. Patent foramen ovale was observed on the TEE of 14 (24.1%) patients, and 3 patients had mitral annulus calcification. Three patients had rheumatic heart disease. Echocardiography demonstrated simple and severe aortic arch atheroma in 30 (51.7%) and 11 (19.0%) subjects, respectively. Mean left ventricular ejection fraction was 52.67 (SD=5.63) among our participants; 9 (15.5%) of them had impaired left ventricular function (ejection fraction<50%). Mean left atrial appendage flow velocity was 65.77 (SD=25.12), and 17 (29.3%) subjects had left atrial appendage flow velocity<55 cm/sec.
Conclusions: Different cardiac abnormalities were seen among stroke cases of unidentified causes. Because relatively high abnormalities were detected in these patients, the role of immediate cardiologic studies-especially echocardiography and Holter monitoring—in first-time stroke patients should be emphasized.