Predictors of Ischemic Stroke in Rheumatic Heart Disease

J Stroke Cerebrovasc Dis. 2015 Dec;24(12):2810-5. doi: 10.1016/j.jstrokecerebrovasdis.2015.08.014. Epub 2015 Sep 26.

Abstract

Background: Studies on predictors of ischemic strokes caused by rheumatic heart disease (RHD) are sparse and extremely important for identifying high-risk cases to direct future therapeutic trials for prevention of ischemic stroke in this population.

Objective: The aim of the present study was to study the predictors of ischemic stroke in patients with RHD and to observe outcome of patients with ischemic stroke at 3 months' follow-up using modified Rankin scale.

Methods: We conducted a case-control study comparing the clinical profile of 40 adult patients with acute ischemic stroke caused by RHD with equal numbers of matched controls comprising patients with RHD without any prior history of stroke. We also observed the functional outcome of ischemic strokes in these patients.

Results: The presence of left atrial spontaneous echo contrast (odds ratio = 39.9; 95% confidence interval, 3.16-501.9; P = .004) and atrial fibrillation (AF) (odds ratio = 3.2; 95% confidence interval, 1.6-6.7; P = .002) was significantly associated with stroke occurrence in RHD populations. The outcome of patients was good with low mortality and significant improvement of modified Rankin scale at 3 months' follow-up.

Conclusions: Presence of AF and left atrial spontaneous echo contrast are significant risk factors for ischemic stroke in patients with RHD. There is high percentage of subclinical AF in this population. Future large clinical trials for oral anticoagulation/antiplatelet agents are needed for stroke prevention in high-risk RHD patients identified by a detailed workup.

Keywords: Rheumatic heart disease; atrial fibrillation; embolic stroke; ischemic stroke; outcome; predictors of stroke; spontaneous echo contrast.

MeSH terms

  • Adolescent
  • Adult
  • Atrial Fibrillation / complications*
  • Brain Ischemia / etiology*
  • Case-Control Studies
  • Female
  • Humans
  • Middle Aged
  • Rheumatic Heart Disease / complications*
  • Risk Assessment
  • Risk Factors
  • Stroke / etiology*
  • Young Adult