VALVULAR STRANDS AND CEREBRAL-ISCHEMIA - EFFECT OF DEMOGRAPHICS AND STRAND CHARACTERISTICS

Background and Purpose Valvular strands, thin filamentous material att ached to the mitral or aortic valve, are seen during transesophageal e chocardiography and have been associated with stroke. Little is known about this association in different age, sex, and race-ethnic subgroup s and the effect of various strand characteristics on this association . Methods From patients referred for transesophageal echocardiography, 73 patients with recent ischemic stroke (68) or transient ischemic at tack (5) were age matched to 73 stroke- and transient ischemic attack- free control subjects. The association between valvular strands and ce rebral ischemia was ;evaluated for the overall group and demographic s ubgroups. The effect of strand location, length, number, and valve thi ckness was also determined. Results An association between cerebral is chemia and valvular strands was observed (odds ratio [OR]=4.4; 95% con fidence interval [CI]=2.0 to 9.6). The association was found for both men and women and among all three race-ethnic groups. The OR was great er in those who were younger (12.5 [95% CI=2.4 to 64.5] for age<60, 4. 8 [95% CI=1.3 to 18.2] for age 60 to 69, and 1.8 [95% CI=0.5 to 6.4] f or age greater than or equal to 70 years). Strands on both the mitral (OR=3.5; 95% CI=1.5 to 7.9) and aortic (OR=3.7; 95% CI=1.1 to 11.9) va lve were associated with cerebral ischemia, whereas the number and len gth of strands were not. The effect of strands was independent of mitr al or aortic valve thickness. Conclusions Valvular strands, whether mi tral or aortic, are associated with ischemic stroke, especially among younger persons.