Valvular strands and cerebral ischemia: Effect of demographics and strand characteristics

Background and Purpose: Valvular strands, thin filamentous material attached to the mitral or aortic valve, are seen during transesophageal echocardiography and have been associated with stroke. Little is known about this association in different age, sex, and race-ethnic subgroups 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 attack (5) were age matched to 73 stroke-and transient ischemic attack-free control subjects. The association between valvular strands and cerebral ischemia was evaluated for the overall group and demographic subgroups. The effect of strand location, length, number, and valve thickness was also determined. Results: An association between cerebral ischemia and valvular strands was observed (odds ratio [OR]=4.4; 95% confidence 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 greater 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] for age ≤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) valve were associated with cerebral ischemia, whereas the number and length of strands were not. The effect of strands was independent of mitral or aortic valve thickness. Conclusions: Valvular strands, whether mitral or aortic, are associated with ischemic stroke, especially among younger persons.