Document Detail

Silent myocardial ischemia in patients with symptomatic intracranial atherosclerosis: associated factors.
MedLine Citation:
PMID:  15879333     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: Optimization of coronary risk evaluation in stroke patients has been encouraged. The relationship between symptomatic intracranial atherosclerosis and occult coronary artery disease (CAD) has not been evaluated sufficiently. We aimed to investigate the prevalence of silent myocardial ischemia in patients with symptomatic intracranial atherosclerosis and to identify factors associated with its presence. METHODS: From 186 first-ever transient ischemic attack or ischemic stroke patients with intracranial stenoses, 65 fulfilled selection criteria, including angiographic confirmation of a symptomatic atherosclerotic stenosis and absence of known CAD. All patients underwent a maximal-stress myocardial perfusion single-photon emission computed tomography (SPECT). Lipoprotein(a) [Lp(a)], C-reactive protein, and homocysteine (Hcy) levels were determined before SPECT. RESULTS: Stress-rest SPECT detected reversible myocardial perfusion defects in 34 (52%) patients. Vascular risk factors associated with a pathologic SPECT were hypercholesterolemia (P=0.045), presence of >2 risk factors (P=0.004) and high Lp(a) (P=0.023) and Hcy levels (P=0.018). Ninety percent of patients with high Lp(a) and Hcy levels had a positive SPECT. Existence of a stenosed intracranial internal carotid artery (ICA; odds ratio [OR], 7.22, 2.07 to 25.23; P=0.002) and location of the symptomatic stenosis in vertebrobasilar arteries (OR, 4.89, 1.19 to 20.12; P=0.027) were independently associated with silent myocardial ischemia after adjustment by age, sex, and risk factors. CONCLUSIONS: More than 50% of the patients with symptomatic intracranial atherosclerosis and not overt CAD show myocardial perfusion defects on stress-rest SPECT. Stenosed intracranial ICA, symptomatic vertebrobasilar stenosis and presence of high Lp(a) and Hcy levels may characterize the patients at a higher risk for occult CAD.
Juan F Arenillas; Jaume Candell-Riera; Guillermo Romero-Farina; Carlos A Molina; Pilar Chacón; Santiago Aguadé-Bruix; Joan Montaner; Gustavo de León; Joan Castell-Conesa; José Alvarez-Sabín
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2005-05-05
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  36     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2005 Jun 
Date Detail:
Created Date:  2005-05-25     Completed Date:  2006-01-18     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1201-6     Citation Subset:  IM    
Department of Neurology, Vall d'Hebron Universitary Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
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MeSH Terms
C-Reactive Protein / biosynthesis
Coronary Angiography
Coronary Artery Disease / pathology
Exercise Test
Homocysteine / blood
Intracranial Arteriosclerosis / complications*,  diagnosis*
Lipoprotein(a) / blood
Middle Aged
Myocardial Ischemia / diagnosis*,  pathology
Myocardium / pathology*
Odds Ratio
Radionuclide Imaging
Risk Factors
Technetium Tc 99m Sestamibi / pharmacology
Tomography, Emission-Computed, Single-Photon
Reg. No./Substance:
0/Lipoprotein(a); 109581-73-9/Technetium Tc 99m Sestamibi; 454-28-4/Homocysteine; 9007-41-4/C-Reactive Protein

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