Comparison of frequencies of patent foramen ovale and thoracic aortic atherosclerosis in patients with cryptogenic ischemic stroke undergoing transesophageal echocardiography.

Studies have shown an association between the presence of a patent foramen ovale (PFO) and cryptogenic stroke (CS) in patients aged <55 years. In addition, protruding atheromatous plaques in the ascending aorta and aortic arch are an independent risk factor for ischemic stroke in patients aged ≥55 years. The aim of this study was to determine the association of CS in the 2 age groups with PFO and with atheromatous plaques in the ascending aorta and in the aortic arch. Transesophageal echocardiograms in 229 patients evaluated for CS were compared to those in 314 patients evaluated for cardiac disease other than PFO with no histories of stroke (the control group). The prevalence of PFO and the presence of complex atheromatous plaques in the ascending aorta and aortic arch were determined in all patients and compared between the CS and control patients in the 2 age groups. The prevalence of PFO was significantly higher in patients with CS than in control patients among those aged <55 years (31 of 114 [27%] vs 24 of 171 [14%], p = 0.006) and those aged ≥55 years (28 of 115 [24%] vs 21 of 143 [15%], p = 0.049). The incidence of atrial septal aneurysm was similar in the 2 groups irrespective of patient age, as was the prevalence of complex atheromatous plaques. Multivariate analysis showed that PFO was independently associated with CS, irrespective of patient age (<55 years: odds ratio 2.4, 95% confidence interval 1.3 to 4.5, p = 0.01; ≥55 years: odds ratio 1.9, 95% confidence interval 1.1 to 3.5, p = 0.03). In conclusion, PFO was significantly associated with CS in younger (aged <55 years) and older (aged ≥55 years) patients. Atrial septal aneurysm and complex atheromas in the ascending aorta and aortic arch do not appear to be associated with CS.

Echocardiographic determination of the prevalence of primary myxomatous degeneration of the cardiac valves.

BACKGROUND: There is a paucity of data on the prevalence of primary myxomatous degeneration (PMD) of the cardiac valves. Because the gold standard for the diagnosis is pathology, its preoperative detection rate is relatively low. The purposes of this study were to determine the capability of echocardiography to identify PMD compared with surgical pathological findings and to determine the echocardiographic features of PMD. METHODS: Echocardiograms were retrospectively compared with pathologic findings in 1,080 patients undergoing surgery for moderate or severe cardiac valve regurgitation. PMD of the mitral, aortic, and tricuspid valves was retrospectively identified, with a comparison of the echocardiographic and pathologic findings, to estimate the prevalence of PMD and to summarize its echocardiographic features. RESULTS: Of 1,080 patients, 104 were diagnosed with PMD (prevalence, 9.62%). Echocardiography identified valvular prolapse and thickening in 85% of patients. The echocardiographic characteristics of PMD included valvular regurgitation, valvular thickening, valvular prolapse, and rupture of chordae tendineae. Combinations of these characteristics were seen on multiple valves. Among patients with PMD, 59 had only mitral valve involvement, 25 had only aortic valve involvement, two had only tricuspid valve involvement, 10 had both mitral and aortic valve involvement, and three had both mitral and tricuspid valve involvement. CONCLUSIONS: In patients undergoing surgery for valvular regurgitation, a high prevalence of PMD was found. PMD has distinctive echocardiographic features, suggesting its preoperative diagnosis.

Relation between the incidence, location, and extent of thoracic aortic atherosclerosis detected by transesophageal echocardiography and the extent of coronary artery disease by angiography.

Atherosclerotic lesions in the thoracic aorta detected by transesophageal echocardiography (TEE) have been correlated with coronary artery disease (CAD). We determined whether simple or complex aortic plaques seen on transesophageal echocardiogram correlated with extent, location, and severity of CAD. The study population consisted of 188 patients who underwent TEE and coronary angiography. Atherosclerotic plaques seen on transesophageal echocardiogram were defined as (1) complex plaques in the presence of protruding atheroma ≥4-mm thickness, mobile debris, or plaque ulceration or (2) simple plaques in the absence of findings consistent with complex plaques. Extent of CAD was grouped into 4 groups according to number of coronary vessels with ≥70% stenosis. Numbers of patients with CAD with 0-, 1-, 2-, and 3-vessel disease were 99, 31, 28, and 30 respectively. Compared to patients without CAD, patients with CAD (n = 89) had a significantly greater prevalence of aortic atherosclerotic plaques irrespective of degree of plaque complexity or location (p <0.05). Multivariate analysis found that hypertension (odds ratio 3.0, 95% confidence interval 1.3 to 7.0, p = 0.013), diabetes mellitus (odds ratio 2.4, 95% confidence interval 1.1 to 4.9, p = 0.022), and aortic plaque (odds ratio 3.8, 95% confidence interval 1.8 to 8.2, p = 0.001) were significantly associated with CAD. There was a significant relation between simple and complex aortic plaques with increasing severity of CAD (p <0.001). Multivariate logistic regression analysis showed that complex plaque in the descending aorta (odds ratio 5.4, 95% confidence interval 1.8 to 16.4, p = 0.003) was the strongest predictor of CAD. In conclusion, simple and complex thoracic atherosclerotic plaques detected by TEE are associated with increasing severity of CAD. Complex plaque in the descending aorta was the strongest association with presence of CAD.