Lacunar stroke: Transoesophageal echocardiographic factors influencing long-term prognosis

Objective: Since little is known concerning factors which may influence lon g-term prognosis of patients presenting with lacunar stroke, we conducted a longitudinal study of this stroke subtype. Variables likely to affect outc ome were assessed at baseline, including those from transoesophageal echoca rdiographic studies. Methods: Consecutive patients presenting with first-ev er lacunar stroke underwent diagnostic workup that included brain CT or MRI , carotid duplex, and transthoracic and transoesophageal echocardiography. An assessment of patients was planned at entry baseline), and thereafter ev ery 12 months (clinic visit or telephone call), drop-out, or endpoint. The primary endpoint was nonfatal or fatal stroke. Secondary endpoint was death due to any cause. Results:Among 60 consecutive lacunar patients with the m ean follow-up period of 3.9 years, 12 patients (20%) had stroke recurrence. The mean annual rate for stroke was 5.2%, and for death 2.8%. For multivar iate Cox proportional hazards analysis, the following three variables with the values of p < 0.1 after univariate testing were chosen: age (p = 0.095) ; aortic atheroma (p = 0.066); and any source of embolism from heart (p = 0 .007). Any source of embolism from heart was the only factor which signific antly enhanced the risk of stroke recurrence (p = 0.015). Using Kaplan-Meie r life table analysis, the curves of percent free of recurrent stroke were significantly different (log rank test p = 0.002). Conclusions: Until the m echanism of lacunar stroke is better understood, it is reasonable to sugges t that its investigation and prevention should be directed at all potential causes of future strokes including cardioembolism. Copynght (C) 2001 S. Ka rger AG, Basel.