Lack of Evidence of an Association between Mitral-Valve Prolapse and Stroke in Young Patients

Gilon, Dan; Buonanno, Ferdinando S.; Joffe, Marshall M.; Leavitt, Marcia; Marshall, Jane E.; Kistler, J P; Levine, Robert A.

doi:10.1056/nejm199907013410102

Cited by 145 publications

(58 citation statements)

References 34 publications

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“…More recent observational cohort and case-control studies have not confirmed an association. [496][497][498] In the midst of some lingering uncertainty in this area, observational studies provide reassuring information that the risk for stroke in people with mitral valve prolapse is low (<1% annually). [499][500][501][502] No randomized trials have addressed the efficacy of antithrombotic therapies for this specific subgroup of stroke or TIA patients.…”

Section: Mitral Valve Regurgitation and Mitral Valve Prolapsementioning

confidence: 99%

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

Kernan¹,

Ovbiagele²,

Black³

et al. 2014

Stroke

3,949

1,326

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The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines.

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Section: Mitral Valve Regurgitation and Mitral Valve Prolapsementioning

confidence: 99%

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

Kernan¹,

Ovbiagele²,

Black³

et al. 2014

Stroke

3,949

1,326

View full text Add to dashboard Cite

show abstract

“…Our results however were discordant with Gilon et al (20) ,they performed a casecontrol study, and reviewed data on 213 consecutive patients 45 years of age or younger with documented ischemic stroke or transient ischemic attack. The prevalence of prolapse in these patients was compared with that in 263 control subjects without known heart disease.…”

Section: **Motor Deficitsupporting

confidence: 71%

Transesophageal Echo Study in Patients With Acute Ischemic Stroke

Mansour

Elzaki

El-Sharkawy

et al. 2014

Zagazig University Medical Journal

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Background: Stroke is one of the major causes of death and disability and due to the high mortality and morbidity rates associated with stroke ,it is becoming a major community health problem worldwide. It has been estimated that cardiogenic emboli are a source of transient ischemic attack (TIA) or stroke in 20% to 40% of all cases. Transesophageal echocardiography (TEE) has been proven superior to transthoracic echocardiography (TTE) for the detection of potential sources of cardiac embolism in patients with previous stroke. In particular, the additional value of TEE in the patients above 45 years of age, in whom TEE is still far from routine procedure, was evaluated. In addition, emphasis was placed on therapeutic consequences, ie, the indication for anticoagulation, based on the results of TEE. Aim of the work : The aim of our study is to evaluate the role of TEE (transesophagealecho) to find indications of anticoagulation despite false absence of its benefit by clinical and transthoracicecho (TTE) examination. Patient and methods:The study was conducted in Zagazig university hospitals and included 100 patients diagnosed with ischemic stroke The diagnosis of stroke was made based on clinical data and brain CT. A full TEE was done and the presence of the following potential sources of embolism was specifically examined (a)left atrial spontaneous echo contrast and thrombus , (b)Impaired Left atrial appendage velocity and the presence of LAA (Left atrial appendage )thrombi , (c)Atheroma in the thoracic aorta, (d)Patent foramen ovale and atrial septal aneurysm (e) others, including valvular vegetations and intracardiac masses . Results:Among the different age groups studied , the prevalence of PFO and MVP (mitral valve prolapse) were highest in patients ˂ 45 years old while the prevalence of complex aortic atheroma was highest in patients ˃45 years old .Risk of stroke recurrence was highest in patients with complex aortic atheroma .Among patients with dyslipidemia,prevalance of ischemic stroke was highest in those older than 45 years old and was significantly higher in low HDL (high density lipoprotein ) (˂40 mg/dl ) and high cholesterol (˃200 mg/dl) group.Furthermore, the risk of stroke recurrence was significantly higher in patients with hypercholesterolemia. Conclusion: TEE has proved to be a very useful tool in diagnosing causes of ischemic stroke .The benefit was not only seen in young age (˂45 years old), but also in those in older age groups .

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“…There are also reports of shortened platelet survival and increased platelet coagulant activity in patients with cerebral embolism and mitral valve prolapse (Lewis, 1988). On the other hand, recent population based and case-control studies demonstrated no increased frequency of mitral valve prolapse among patients with stroke or transient ischemic attacks, including young patients (Gilon et al, 1999;Orenica et al, 1995;Petty et al, 1994). In addition, patients with mitral valve prolapse who had strokes were similar in age to the general stroke population, and many had other risk factors for strokes, including atrial fibrillation (Gilon etal., 1999;Nishimura et al, 1985;Orenica et al, 1995).…”

Section: Mitral Valve Prolapsementioning

confidence: 99%

The Thrombogenic Role of Platelets in Valvular Atrial Fibrillation

Azzam¹

2012

Atrial Fibrillation - Basic Research and Clinical Applications

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Lack of Evidence of an Association between Mitral-Valve Prolapse and Stroke in Young Patients

Cited by 145 publications

References 34 publications

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

Transesophageal Echo Study in Patients With Acute Ischemic Stroke

The Thrombogenic Role of Platelets in Valvular Atrial Fibrillation

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