Predictive and clinical value of cerebral microemboli detection in cardnic patients

ABSTRACT

Cardioembolic strokes have a worse prognosis and produce larger and more disabling strokes than other ischemic stroke subtypes. We sought to evaluate the prevalence of High-intensity-transient-signals [HITS] in patients having different cardiac sources of emboli and the value of transcranial Doppler [TCD] in stroke prediction. consecutive cardiac patients were subjected to ECG, transthoracic echocardiography, and TCD examination. a total of 45 cardiac patients were investigated; twenty patients with rheumatic heart disease, 10 with prosthetic valves, and 15 with myocardial ischemia. In all patients, the presence of HITS was not affected by the patients' age, gender, the presence of risk factors, the platelet count or the INR level. Cerebral strokes were significantly higher in patients with HITS than those without. In patients with prosthetic heart valves, 60% was HITS-positive with a mean rate of 14.2 +/- 6.49/ 30 minutes, which was significantly higher than myocardial ischemia and rheumatic heart disease patients. In myocardial ischemia group, a higher prevalence of HITS was found with left ventricular ejection fraction [LVEF] < 55% and left ventricular thrombus.In rheumatic heart and ischemic heart disease groups > 80% of patients treated with antithrombotics and/or thrombolytics did not show any HITS, while in mechanical heart valves only 20% of patients received anticoagulants plus aspirin was HITS-negative. Cerebral strokes are significantly higher in cardiac patients with detected HITS than those without. In patients with prosthetic heart valves, anticoagulants didn 't significantly decrease or clear HITS