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Risk of Recurrent Neurologic Stroke or Transient Ischemic Attack in Patients with Cryptogenic Stroke and Intrapulmonary Shunt
Author(s) -
Sinha Rahul S.,
Hussain Zeeshan,
Bhatia Nirmanmoh,
Stoddard Marcus F.
Publication year - 2016
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13017
Subject(s) - medicine , patent foramen ovale , cardiology , stroke (engine) , warfarin , atrial fibrillation , mechanical engineering , migraine , engineering
Background and Purpose Cardio‐embolic phenomenon is believed to underlie a significant proportion of cryptogenic strokes. We recently showed that intrapulmonary shunt ( IPS ) was associated with cryptogenic stroke and transient ischemic attack ( TIA ). We hypothesized that patients with prior cryptogenic stroke or TIA that had an IPS were at a higher risk for recurrent ischemic events. Methods The population included subjects with cryptogenic cerebrovascular accident ( CVA ) or TIA . Inclusion criteria were age ≥18 years, sinus rhythm, and clinically indicated transesophageal echocardiography ( TEE ). Exclusion criteria were hemorrhagic CVA , septal defect, and patent foramen. Patients were followed from index TEE . Results Of 71 patients, 8 were lost to follow‐up. A total of 23 patients had and 40 were without IPS . Average follow‐up duration was 38.3 ± 19.2 months. Groups were similar at baseline. There was no significant difference in the recurrence of ischemic CVA or TIA in the IPS versus non‐ IPS groups (0% vs. 7.5%; P = NS ). There was no difference between the incidence of hemorrhagic CVA in the IPS and non‐ IPS groups (4.3% vs. 5.0%; P = NS ). The proportion of patients on warfarin in the IPS group was significantly higher compared to the non‐ IPS group (17.4% vs. 0%; P < 0.05). Conclusions Patients with IPS and cryptogenic stroke or TIA did not have a higher recurrence of ischemic cerebral events. Warfarin was significantly higher at follow‐up in the IPS compared to the non‐ IPS group, which may explain these findings. A study randomizing patients with IPS and cryptogenic stroke or TIA to warfarin or no warfarin would be of great interest.