Document Detail

Frequency of atrial septal aneurysms in patients with cerebral ischemic events.
MedLine Citation:
PMID:  10208995     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Atrial septal aneurysm (ASA) is a putative risk factor for cardioembolism. However, the frequency of ASA in the general population has not been adequately determined. Therefore, the frequency in patients with cerebral ischemic events, compared with the frequency in the general population, is poorly defined. We sought to determine the frequency of ASA in the general population and to compare the frequency of ASA in patients with cerebral ischemic events with the frequency in the general population. METHODS AND RESULTS: The frequency of ASA in the population was determined in 363 subjects, a sample of the participants in the Stroke Prevention: Assessment of Risk in a Community study (control subjects), and was compared with the frequency in 355 age- and sex-matched patients undergoing transesophageal echocardiography in search of a cardiac source of embolism after a focal cerebral ischemic event. The proportion with ASA was 7.9% in patients versus 2.2% in control subjects (P=0.002; odds ratio of ASA, 3.65; 95% CI, 1.64 to 8.13, in patients versus control subjects). Patent foramen ovale (PFO) was detected with contrast injections in 56% of subjects with ASA. The presence of ASA predicted the presence of PFO (odds ratio of PFO, 4.57; 95% CI, 2.18 to 9.57, in subjects with versus those without ASA). In 86% of subjects with ASA and cerebral ischemia, transesophageal echocardiography did not detect an alternative source of cardioembolism other than an associated PFO. CONCLUSIONS: The prevalence of ASA based on this population-based study is 2.2%. The frequency of ASA is relatively higher in patients evaluated with transesophageal echocardiography after a cerebral ischemic event. ASA is frequently associated with PFO, suggesting paradoxical embolism as a mechanism of cardioembolism. In patients with cerebral ischemia and ASA, ASA (with or without PFO) commonly is the only potential cardioembolic source detected with transesophageal echocardiography.
Y Agmon; B K Khandheria; I Meissner; F Gentile; J P Whisnant; J D Sicks; W M O'Fallon; J L Covalt; D O Wiebers; J B Seward
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Circulation     Volume:  99     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  1999 Apr 
Date Detail:
Created Date:  1999-04-30     Completed Date:  1999-04-30     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1942-4     Citation Subset:  AIM; IM    
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
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MeSH Terms
Aged, 80 and over
Brain Ischemia / epidemiology*,  etiology
Echocardiography, Transesophageal
Heart Aneurysm / complications,  epidemiology*
Heart Atria
Heart Diseases / complications,  epidemiology
Heart Septum*
Intracranial Embolism and Thrombosis / epidemiology*,  etiology
Middle Aged
Minnesota / epidemiology
Risk Factors
Grant Support
Comment In:
Circulation. 2000 May 30;101(21):E210   [PMID:  10831538 ]
Circulation. 2000 Jul 25;102(4):E27   [PMID:  10908225 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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