CARDIAC SOURCES OF EMBOLISM IN TERRITORIA L TYPE BRAIN INFARCT

Background and purpose: To test the association of cardiac sources of embolism with territorial type brain infarcts Methods: From a prospect ive cerebral ischemia data base the 106 consecutive patients with terr itorial type cerebral infarcts on computerized tomography were analyze d. The 85 consecutive patients with lacunar lesions served as a compar ison group. The association of cardiac sources of embolism with territ orial types infarcts was assessed using univariate Chi Square tests an d logistic regression models. Cardiac sources of embolism were defined as: atrial fibrillation,left cardiac thrombi, valvular vegetations, w all motion and valvular abnormalities, left atrial enlargement, open f oramen ovale, septal aneurysm, mitral valve prolaps, and aortic arch a therothrombosis (all findings-except for atrial fibrillation - assesse d by echocardiography). Results: Atrial fibrillation was significantly associated with territorial type infarcts (odds ratio 2.2, 95% convid ence interval 1.01-4.8). This effect was independent of additional car diac diseases, other cardiac abnormalities, carotid artery stenosis, a nd patient age. Most likely due to the small sample size, left cardia c thrombi only showed a non-significant trend towards an association w ith territorial infarcts (odds ratio 3.0, 95% confidence interval 0.7- 12.3). The rate of all other cardiac findings did not differ significa ntly between the comparison groups. Conclusion: Atrial fibrillation an d cardiac thrombi showed an association with territorial type infarcts . Other so-called cardiac sources of embolism - except for mechanical valves and bacterial endocarditis which were not represented in our sa mple - revealed no clinically relevant association with embolic brain infarct pattern.