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Transthoracic echocardiographic and clinical predictors in first versus recurrent ischemic strokes

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DOI: 10.4236/wjcd.2014.42011    2,962 Downloads   4,182 Views   Citations

ABSTRACT

Recurrent strokes are more likely to be disabling or fatal than first ever strokes. The aim of the study is to evaluate transthoracic echocardiographic (TTE) and clinical predictors in patients with first versus those with recurrent ischemic strokes. A prospective observational comparative study of 217 patients admitted with ischemic strokes who were in sinus rhythm. Two groups of patients were simultaneously enrolled. The first group was 110 patients with first ischemic stroke and the second was 107 patients with recurrent ischemic stroke. TTE was done for all patients. Both echocardiographic and clinical risk factors were compared between both groups. Logistic regression analysis identified predictors for recurrent strokes. Among clinical risk factors hypertension, hyperlipidemia, family history of atherosclerotic vascular disease, prior coronary artery disease, peripheral vascular disease, and chronic kidney disease were significantly higher in recurrent stroke group. Multivariate logistic analysis identified age (OR, 1.03; 95% CI, 1.01 - 1.07), hypertension (OR, 2.25; 95% CI, 1.03 - 4.92), and hyperlipidemia (OR, 2.73; 95% CI, 1.40 - 5.35), as predictors for recurrent ischemic strokes. Left ventricular diastolic dysfunction, left ventricular hypertrophy (LVH) and aortic sclerosis were significantly more common in the recurrent stroke group compared to the first stroke group. However, in multivariate logistic analysis only LVH (OR, 3.50; 95% CI, 1.69 - 7.23), was identified as a predictor for recurrent strokes. Older age, hypertension, hyperlipidemia and left ventricular hypertrophy are significant predictors of recurrent ischemic strokes in patients with sinus rhythm. Those patients need more aggressive lipid lowering therapy and optimal blood pressure control.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Bahnacy, Y. , Koora, A. , Dawoud, H. , Rashed, W. and Sadek, A. (2014) Transthoracic echocardiographic and clinical predictors in first versus recurrent ischemic strokes. World Journal of Cardiovascular Diseases, 4, 70-76. doi: 10.4236/wjcd.2014.42011.

References

[1] Bonita, R. (1992) Epidemiology of stroke. Lancet, 339, 342-344. http://dx.doi.org/10.1016/0140-6736(92)91658-U
[2] Hardie, K., Jamrozik, K., Hankey, G.J., Broadhurst, R.J. and Anderson, C. (2005) Trends in five-year survival and risk of recurrent stroke after first-ever stroke in the Perth Community Stroke Study. Cerebrovascular Diseases, 19, 179-185.
http://dx.doi.org/10.1159/000083253
[3] Sacco, R.L., Shi, T., Zamanillo, M.C. and Kargman, D.E. (1994) Predictors of mortality and recurrence after hospitalized cerebral infarction in an urban community: The northern manhattan stroke study. Neurology, 44, 626-634. http://dx.doi.org/10.1212/WNL.44.4.626
[4] Leoo, T., Lindgren, A., Petersson, J. and von Arbin, M. (2008) Risk Factors and Treatment at Recurrent Stroke Onset: Results from the Recurrent Stroke Quality and Epidemiology (RESQUE) Study. Cerebrovascular Diseases, 25, 254-260.
http://dx.doi.org/10.1159/000113864
[5] Feinberg, W.M., Blackshear, J.L., Laupacis, A., Kronmal, R. and Hart, R.D. (1995) Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications. JAMA Internal Medicine, 155, 469-473.
http://dx.doi.org/10.1001/archinte.1995.00430050045005
[6] Donnan, G.A., Fisher, M., Macleod, M. and Davis, S.M. (2008) Stroke. Lancet, 371, 1612-1623.
http://dx.doi.org/10.1016/S0140-6736(08)60694-7
[7] Sacco, R.L., Foulkes, M.A., Mohr, J.P., Wolf, P.A., Hier, D.B. and Price, T.R. (1989) Determinants of early recurrence of cerebral infarction: The Stroke Data Bank. Stroke, 20, 983-989.
http://dx.doi.org/10.1161/01.STR.20.8.983
[8] Hier, D.B., Foulkes, M.A., Swiontoniowski, M., Sacco, R.L., Gorelick, P.B., Mohr, J.P., et al. (1991) Stroke recurrence within 2 years after ischemic infarction. Stroke, 22, 155-161.
http://dx.doi.org/10.1161/01.STR.22.2.155
[9] Lang, R.M., Bierig, F.M., Devereux, R.B., Flachskampf, F.A., Foster, E., Pellikka, P.A., et al. (2005) Recommendations for chamber quantification: A report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group. Journal of the American Society of Echocardiography, 18, 1440-1463.
http://dx.doi.org/10.1016/j.echo.2005.10.005
[10] Goldstein, L.B., Matchar, D.B., Hoff-Lindquist, J., Samsa, G.P. and Homer, R.D. (2003) Veterans Administration Acute Stroke (VASt) Study: Lack of race/ethnic-based differences in utilization of stroke-related procedures or services. Stroke, 34, 999-1004.
http://dx.doi.org/10.1161/01.STR.0000063364.88309.27
[11] Cereda, M. and Trocino, G. (2002) Echocardiography in patients with acute cerebrovascular syndromes. Rational use and clinical impact. Italian heart journal. Supplement, 3, 26-35.
[12] Blum, A., Reisner, S. and Farbstein, Y. (2004) Transesophageal echocardiography (TEE) vs. transthoracic echocardiography (TTE) in assessing cardiovascular sources of emboli in patients with acute ischemic stroke. Medical Science Monitor, 10, CR521-CR523.
[13] Leung, D.Y., Black, I.W., Cranney, G.B., Walsh, W.F., Grimm RA, Stewart WJ, et al. (1995) Selection of patients for transesophageal echocardiography after stroke and systemic embolic events: role of transthoracic echocardiography. Stroke, 26, 1820-1824.
http://dx.doi.org/10.1161/01.STR.26.10.1820
[14] Gambini, C. and Paciaroni, E. (1995) The role of transesophageal echocardiography in the diagnosis of ischemic stroke in the elderly. Archives of Gerontology and Geriatrics, 20, 37-42.
http://dx.doi.org/10.1016/0167-4943(94)00603-5
[15] Semple, P.F. and Sacco, R.L. (1999) An Atlas of Stroke. 2nd Edition, the Parthenon Publishing Group, London, 24.
[16] Douen, A., Pageau, N. and Medic, S. (2007) Usefulness of cardiovascular investigations in stroke management. Clinical relevance and economic implications. Stroke, 38, 1956-58.
http://dx.doi.org/10.1161/STROKEAHA.106.477760
[17] Albers, G.W., Amarenco, P., Easton, J.D., Sacco, R.L. and Teal, P. (2004) Antithrombotic and thrombolytic therapy for ischemic stroke: The seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest, 126, S483-S512.
[18] Nalluri, C., Jain, N., Dalton, N.D., Fox, K. and Hoit, B.D. (2002) The role of transesophageal echocardiography in the evaluation of embolic stroke: Is management altered. Cardiac Ultrasound Today, 8, 97-117.
[19] Rem, J.A., Hachinski, V.C., Boughner, D.R. and Bemett, H.J. (1985) Value of cardiac monitoring and echocardiography in TIA and stroke patients. Stroke, 16, 950-956.
http://dx.doi.org/10.1161/01.STR.16.6.950
[20] Ezekowitz, M., Laupacis, A., Boysen, G., Connolly, S., Hart, R., James, K., et al. (1998) Echocardiographic predictors of stroke in patients with atrial fibrillation. A prospective study of 1066 patients from 3 clinical trials. JAMA Internal Medicine, 158, 1316-1320.
http://dx.doi.org/10.1001/archinte.158.12.1316
[21] SPAF Investigators. (1992) Predictors of thromboembolism in atrial fibrillation, II: Echocardiographic features of patients at risk-the stroke prevention in atrial fibrillation investigators. Annals of Internal Medicine, 116, 6-12.
http://dx.doi.org/10.7326/0003-4819-116-1-6
[22] SPAF Investigators. (1995) Risk factors for thromboembolism during aspirin therapy in patients with atrial fibrillation. Journal of Stroke and Cerebrovascular Diseases, 5, 147-157.
http://dx.doi.org/10.1016/S1052-3057(10)80166-1
[23] Barech, M.S., Sadiq, S.M., Zarkoon, A.K. and Gulandam, K. (2010) Risk factors for ischemic stroke in patients attending a tertiary hospital in Quetta. Pakistan Journal of Neurological Sciences, 5, 1-5.
[24] Ayala, C., Croft, J.B., Greenlund, K.J., Keenan, N.L., Donehoo, R.S., Malarcher, A.M., et al. (2002) Sex differences in US mortality rates for stroke and stroke subtypes by race/ethnicity and age, 1995-1998. Stroke, 33, 1197-1201. http://dx.doi.org/10.1161/01.STR.0000015028.52771.D1
[25] Peter, A., Birgitta, S. and Andreas, T. (2009) Sex differences in stroke epidemiology: A systematic review. Stroke, 40, 1082-1090.
http://dx.doi.org/10.1161/STROKEAHA.108.540781
[26] Eyal, S., Lloyd, E.C., Wayne, D.R., Lori, L.B., Christie, M.B., Paul, G.M., et al. (2003) Plasma lipid profile and incident ischemic stroke: The atherosclerosis risk in communities (ARIC) study. Stroke, 34, 623-631.
http://dx.doi.org/10.1161/01.STR.0000057812.51734.FF
[27] David, J.C., Robert, D.A., Charles, J.M., Beatriz, L.R., Cecil, M.B., Dan, S.S., et al. (1996) Age-related changes in stroke risk in men with hypertension and normal blood pressure. Stroke, 27, 819-824.
http://dx.doi.org/10.1161/01.STR.27.5.819
[28] Toshio, H., Seinosuke, K., Hideki, I., Nobuhiro, Y., Hirohito, S., Hircshi, W., et al. (2009) Low HDL cholesterol is associated with the risk of stroke in elderly diabetic individuals. Diabetes Care, 32, 1221-23.
http://dx.doi.org/10.2337/dc08-1677
[29] Valery, L.F., David, O.W., Yury, P.N., Michael, W.F. and Jack, P.W. (1998) Risk factors for ischemic stroke in a Russian community a population-based case-control study. Stroke, 29, 34-39.
http://dx.doi.org/10.1161/01.STR.29.1.34
[30] Ong, T.Z. and Raymond, A.A. (2002) Risk factors for stroke and predictors of one-month mortality. Singapore Medical Journal, 43, 517-521.
[31] Brett, M.K., Jane, K., Dawn, K., Daniel, A., Alexander, S., Kathleen A, et al. (2005) Epidemiology of ischemic stroke in patients with diabetes. Diabetes Care, 28, 355-359.
http://dx.doi.org/10.2337/diacare.28.2.355
[32] Tanika, N.K., Gu, D.F., Jing, C., Huang, J.-F., Chen, J.-C., Duan, X.F., et al. (2008) Cigarette smoking and risk of stroke in the Chinese adult population. Stroke, 39, 1688-1693. http://dx.doi.org/10.1161/STROKEAHA.107.505305
[33] Jeroen, N.S., van Genugten, M.L.L., Silivia, M.A., Andre, J.A., Caroline, A.B., et al. (2005) Modeling the future burden of stroke in the Netherlands impact of aging, smoking, and hypertension. Stroke, 36, 1648-1655.
http://dx.doi.org/10.1161/01.STR.0000173221.37568.d2

  
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