Impact of valvular thickness on stroke recurrence in medically treated patients with stroke

K. Okajima, Y. Abe, K. Suzuki, M. J. Salameh, M. R. Di Tullio, Z. Jin, Ralph L Sacco, J. P. Mohr, S. Homma

Research output: Contribution to journalArticle

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Abstract

Background: It remains controversial whether left-sided valvular thickening (VaT) is a risk factor for ischemic stroke. Little is known about the relationship between VaT and the recurrent adverse event rate in medically treated patients with stroke. Methods: We examined the outcomes of 627 noncardioembolic stroke patients who were double-blindly assigned to either warfarin or aspirin therapy and assessed VaT using transesophageal echocardiography. Endpoints were recurrent ischemic stroke or death from any cause. The Cox proportional hazards model was used to adjust for covariates. Results: VaT was present in 57.3% of the patients (359/627), 34.6% (271/627) involving the aortic valve and 46.4% (291/627) involving the mitral valve. There was no difference in the time to primary endpoints between those with and without VaT of the aortic valve (p = 0.49; hazard ratio, HR: 1.17; 95% CI: 0.74-1.85; 2-year event rates: 18.9 vs. 13.2%) or mitral valve (p = 0.66; HR: 0.91; 95% CI: 0.60-1.38; 2-year event rates: 16.9 vs. 14.7%). Among the patients with VaT, there was no significant difference in the time to primary endpoints between those treated with warfarin and those with aspirin (p = 0.13, HR: 0.65, 95% CI: 0.37-1.14, 2-year event rates: 15.2 vs. 22.7% for the aortic valve; p = 0.22, HR: 0.70, 95% CI: 0.40-1.23, 2-year event rates: 14.2 vs. 19.6% for the mitral valve). Conclusions: VaT does not appear to increase recurrent adverse event rates in medically treated patients with ischemic stroke, regardless of warfarin or aspirin therapy.

Original languageEnglish
Pages (from-to)375-380
Number of pages6
JournalCerebrovascular Diseases
Volume24
Issue number4
DOIs
StatePublished - Sep 1 2007
Externally publishedYes

Fingerprint

Stroke
Recurrence
Warfarin
Aortic Valve
Mitral Valve
Aspirin
Transesophageal Echocardiography
Proportional Hazards Models
Cause of Death
Therapeutics

Keywords

  • Heart valves
  • Stroke
  • Transeosophageal echocardiography

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Okajima, K., Abe, Y., Suzuki, K., Salameh, M. J., Di Tullio, M. R., Jin, Z., ... Homma, S. (2007). Impact of valvular thickness on stroke recurrence in medically treated patients with stroke. Cerebrovascular Diseases, 24(4), 375-380. https://doi.org/10.1159/000107918

Impact of valvular thickness on stroke recurrence in medically treated patients with stroke. / Okajima, K.; Abe, Y.; Suzuki, K.; Salameh, M. J.; Di Tullio, M. R.; Jin, Z.; Sacco, Ralph L; Mohr, J. P.; Homma, S.

In: Cerebrovascular Diseases, Vol. 24, No. 4, 01.09.2007, p. 375-380.

Research output: Contribution to journalArticle

Okajima, K, Abe, Y, Suzuki, K, Salameh, MJ, Di Tullio, MR, Jin, Z, Sacco, RL, Mohr, JP & Homma, S 2007, 'Impact of valvular thickness on stroke recurrence in medically treated patients with stroke', Cerebrovascular Diseases, vol. 24, no. 4, pp. 375-380. https://doi.org/10.1159/000107918
Okajima, K. ; Abe, Y. ; Suzuki, K. ; Salameh, M. J. ; Di Tullio, M. R. ; Jin, Z. ; Sacco, Ralph L ; Mohr, J. P. ; Homma, S. / Impact of valvular thickness on stroke recurrence in medically treated patients with stroke. In: Cerebrovascular Diseases. 2007 ; Vol. 24, No. 4. pp. 375-380.
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abstract = "Background: It remains controversial whether left-sided valvular thickening (VaT) is a risk factor for ischemic stroke. Little is known about the relationship between VaT and the recurrent adverse event rate in medically treated patients with stroke. Methods: We examined the outcomes of 627 noncardioembolic stroke patients who were double-blindly assigned to either warfarin or aspirin therapy and assessed VaT using transesophageal echocardiography. Endpoints were recurrent ischemic stroke or death from any cause. The Cox proportional hazards model was used to adjust for covariates. Results: VaT was present in 57.3{\%} of the patients (359/627), 34.6{\%} (271/627) involving the aortic valve and 46.4{\%} (291/627) involving the mitral valve. There was no difference in the time to primary endpoints between those with and without VaT of the aortic valve (p = 0.49; hazard ratio, HR: 1.17; 95{\%} CI: 0.74-1.85; 2-year event rates: 18.9 vs. 13.2{\%}) or mitral valve (p = 0.66; HR: 0.91; 95{\%} CI: 0.60-1.38; 2-year event rates: 16.9 vs. 14.7{\%}). Among the patients with VaT, there was no significant difference in the time to primary endpoints between those treated with warfarin and those with aspirin (p = 0.13, HR: 0.65, 95{\%} CI: 0.37-1.14, 2-year event rates: 15.2 vs. 22.7{\%} for the aortic valve; p = 0.22, HR: 0.70, 95{\%} CI: 0.40-1.23, 2-year event rates: 14.2 vs. 19.6{\%} for the mitral valve). Conclusions: VaT does not appear to increase recurrent adverse event rates in medically treated patients with ischemic stroke, regardless of warfarin or aspirin therapy.",
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AU - Okajima, K.

AU - Abe, Y.

AU - Suzuki, K.

AU - Salameh, M. J.

AU - Di Tullio, M. R.

AU - Jin, Z.

AU - Sacco, Ralph L

AU - Mohr, J. P.

AU - Homma, S.

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N2 - Background: It remains controversial whether left-sided valvular thickening (VaT) is a risk factor for ischemic stroke. Little is known about the relationship between VaT and the recurrent adverse event rate in medically treated patients with stroke. Methods: We examined the outcomes of 627 noncardioembolic stroke patients who were double-blindly assigned to either warfarin or aspirin therapy and assessed VaT using transesophageal echocardiography. Endpoints were recurrent ischemic stroke or death from any cause. The Cox proportional hazards model was used to adjust for covariates. Results: VaT was present in 57.3% of the patients (359/627), 34.6% (271/627) involving the aortic valve and 46.4% (291/627) involving the mitral valve. There was no difference in the time to primary endpoints between those with and without VaT of the aortic valve (p = 0.49; hazard ratio, HR: 1.17; 95% CI: 0.74-1.85; 2-year event rates: 18.9 vs. 13.2%) or mitral valve (p = 0.66; HR: 0.91; 95% CI: 0.60-1.38; 2-year event rates: 16.9 vs. 14.7%). Among the patients with VaT, there was no significant difference in the time to primary endpoints between those treated with warfarin and those with aspirin (p = 0.13, HR: 0.65, 95% CI: 0.37-1.14, 2-year event rates: 15.2 vs. 22.7% for the aortic valve; p = 0.22, HR: 0.70, 95% CI: 0.40-1.23, 2-year event rates: 14.2 vs. 19.6% for the mitral valve). Conclusions: VaT does not appear to increase recurrent adverse event rates in medically treated patients with ischemic stroke, regardless of warfarin or aspirin therapy.

AB - Background: It remains controversial whether left-sided valvular thickening (VaT) is a risk factor for ischemic stroke. Little is known about the relationship between VaT and the recurrent adverse event rate in medically treated patients with stroke. Methods: We examined the outcomes of 627 noncardioembolic stroke patients who were double-blindly assigned to either warfarin or aspirin therapy and assessed VaT using transesophageal echocardiography. Endpoints were recurrent ischemic stroke or death from any cause. The Cox proportional hazards model was used to adjust for covariates. Results: VaT was present in 57.3% of the patients (359/627), 34.6% (271/627) involving the aortic valve and 46.4% (291/627) involving the mitral valve. There was no difference in the time to primary endpoints between those with and without VaT of the aortic valve (p = 0.49; hazard ratio, HR: 1.17; 95% CI: 0.74-1.85; 2-year event rates: 18.9 vs. 13.2%) or mitral valve (p = 0.66; HR: 0.91; 95% CI: 0.60-1.38; 2-year event rates: 16.9 vs. 14.7%). Among the patients with VaT, there was no significant difference in the time to primary endpoints between those treated with warfarin and those with aspirin (p = 0.13, HR: 0.65, 95% CI: 0.37-1.14, 2-year event rates: 15.2 vs. 22.7% for the aortic valve; p = 0.22, HR: 0.70, 95% CI: 0.40-1.23, 2-year event rates: 14.2 vs. 19.6% for the mitral valve). Conclusions: VaT does not appear to increase recurrent adverse event rates in medically treated patients with ischemic stroke, regardless of warfarin or aspirin therapy.

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KW - Stroke

KW - Transeosophageal echocardiography

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