Risk of Stroke in a Cohort of 815 Patients With Calcification of the Aortic Valve With or Without Stenosis

Boon, Arthur; Lodder, J.; Cheriex, Emile C.; Kessels, Fons

doi:10.1161/01.str.27.5.847

Cited by 64 publications

(29 citation statements)

References 36 publications

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“…Valve calcifications and stroke were examined in two large cohorts; it was concluded that mitral [5]but not aortic [6]valve calcification is a risk factor for stroke. In spite of these findings, we found 5 published cases of documented cerebral SCE from the aortic valve [1, 7, 8, 9, 10].…”

Section: Discussionmentioning

confidence: 99%

Stroke as the First Manifestation of Calcific Aortic Stenosis

et al. 2000

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Heart valve calcifications are rarely recognized as a potential source for cerebral embolism. Previous studies have identified mitral, but not aortic, valve calcifications to be risk factors for stroke. Based on these studies, heart surgery is unlikely to be indicated in patients who present with a stroke and an ‘incidental’ aortic valve calcification. We report a case of a 46-year-old man presenting with acute onset of left-sided weakness and numbness. A previous smoking history was the only cardiovascular risk factor found. Head CT scan revealed a right middle cerebral artery territory infarct and an adjacent high-density lesion. CT angiography demonstrated the presence of calcific embolic material in the middle cerebral artery. A search for embolic sources revealed a calcific aortic stenosis (CAS). Initially placed on coumadin, the patient developed silent myocardial infarction 2 months later, presumed to be also embolic in origin from the CAS. After aortic valve replacement, the patient has been symptom-free during a 2-year follow-up. In conclusion, CT angiography may be the method of choice for detecting calcific cerebral emboli, and demonstration of a causal relationship between CAS and an embolic stroke by CT angiography may be an important adjunct in surgical decision-making.

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Section: Discussionmentioning

confidence: 99%

Stroke as the First Manifestation of Calcific Aortic Stenosis

et al. 2000

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“…6 We hypothesized that calcific AS is associated with the same pathobiology underlying an increase in the CHA 2 DS 2 -VASc score and that the latter, therefore, could be particularly useful for stratifying risk of stroke in earlier stages of AS. This study was, therefore, undertaken to examine the ability of the CHA 2 DS 2 -VASc score to predict ischemic stroke in asymptomatic patients with AS with and without coexisting AF.…”

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Stroke in Patients With Aortic Stenosis

Greve

Dalsgaard

Bang

et al. 2014

Stroke

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T he most recent US and European guidelines for treatment of valvular heart disease recommend oral anticoagulation (OAC) for stroke prophylaxis in all patients with aortic stenosis (AS) complicated by atrial fibrillation (AF).1,2 This recommendation differs from nonvalvular AF, where the decision to start OAC is guided by the CHA 2 DS 2 -VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years and female sex) risk scheme.3 The guideline discrepancy is based on observational studies indicating that calcific AS is an independent risk factor for stroke, 4 which may predict stroke even in the absence of AF.5 However, limited evidence exists on the effectiveness of the CHA 2 DS 2 -VASc scores in AS populations, and particularly in less severe AS where data are equivocal with regards to an increased stroke risk per se. 6 We hypothesized that calcific AS is associated with the same pathobiology underlying an increase in the CHA 2 DS 2 -VASc score and that the latter, therefore, could be particularly useful for stratifying risk of stroke in earlier stages of AS. This study was, therefore, undertaken to examine the ability of the CHA 2 DS 2 -VASc score to predict ischemic stroke in asymptomatic patients with AS with and without coexisting AF. Because risk of new-onset AF and thromboembolism may differ substantially in relation to aortic valve replacement (AVR) with or without coronary artery bypass grafting (CABG), the primary study hypothesis was stratified by AVR with and Background and Purpose-There are limited data on risk stratification of stroke in aortic stenosis. This study examined predictors of stroke in aortic stenosis, the prognostic implications of stroke, and how aortic valve replacement (AVR) with or without concomitant coronary artery bypass grafting influenced the predicted outcomes. Methods-Patients with mild-to-moderate aortic stenosis enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Diabetes mellitus, known atherosclerotic disease, and oral anticoagulation were exclusion criteria. Ischemic stroke was the primary end point, and poststroke survival a secondary outcome. Cox models treating AVR as a time-varying covariate were adjusted for atrial fibrillation and congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years and female sex (CHA 2 DS 2 -VASc) scores. Results-One thousand five hundred nine patients were followed for 4.3±0.8 years (6529 patient

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“…4,5 Several, 6,7 although not all, 8,9 studies have detailed a similar relationship between MAC and stroke, but an independent association between AV calcification and cerebral infarction has only been demonstrated in the presence of AV stenosis. 5,10,11 MAC and AV sclerosis are associated with atherosclerosis risk factors that can promote left ventricular (LV) hypertrophy and left atrial (LA) enlargement, each of which has been reported to predict cerebrovascular events. 12,13 However, available studies linking valvular calcification with cerebral ischemia have adjusted only partly, if at all, for these concurrent echocardiographic predictors.…”

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confidence: 99%

Mitral Annular Calcification, Aortic Valve Sclerosis, and Incident Stroke in Adults Free of Clinical Cardiovascular Disease

Kizer

Wiebers

Whisnant

et al. 2005

Stroke

157

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Background and Purpose-Mitral annular calcification (MAC) and aortic valve (AV) sclerosis have each been linked to cardiovascular disease. Whether MAC and AV sclerosis are risk factors for stroke independent of other echocardiographic or laboratory predictors has not been established. We evaluated the relationship between MAC, AV sclerosis, and first stroke events in a population-based cohort. Methods-Our study cohort consisted of 2723 American Indians participating in the Strong Heart Study who were free of prevalent cardiovascular disease. Participants underwent standardized clinical, echocardiographic, and laboratory evaluation, and incident stroke was ascertained using validated methods. Results-During a median follow-up of 7 years, 86 strokes occurred. Age-and sex-adjusted incidence rates of stroke were significantly increased for MAC (rate ratio [RR], 3.12; 95% CI, 1.77 to 5.25) but not for AV sclerosis (RR, 1.15; 95% CI, 0.45 to 2.49). MAC was also associated with a reduced time to first stroke events after adjustment for clinical variables and the inflammatory markers C-reactive protein and fibrinogen (hazard ratio [HR], 2.42; 95% CI, 1.39 to 4.21) or the echocardiographic covariates left ventricular hypertrophy and left atrial enlargement (HR, 1.89; 95% CI, 1.04 to 3.41). Individuals with and without AV sclerosis showed no significant difference in stroke-free survival in unadjusted analyses (Pϭ0.698). Crossing of the survival curves precluded multivariable analysis using Cox models. Conclusions-In this cohort of American Indians without clinical cardiovascular disease, the presence of MAC, but not AV sclerosis, proved to be a strong risk factor for incident stroke after extensive adjustment for other predictors. Individuals exhibiting MAC may benefit from aggressive risk factor modification, but this will require further investigation. (Stroke. 2005;36:2533-2537.)Key Words: calcium Ⅲ echocardiography Ⅲ heart valves Ⅲ stroke M itral annular calcification (MAC) is characterized by calcium and lipid deposition in the annular fibrosa of the mitral valve, whereas aortic valve (AV) sclerosis results from similar accumulation involving the AV leaflets. 1 Clinical precursors of atherosclerosis are also risk factors for MAC and AV sclerosis, 2,3 and the 2 conditions often exist concurrently. 2 Each, in turn, has been documented to be an independent predictor of cardiovascular events. 4,5 Several, 6,7 although not all, 8,9 studies have detailed a similar relationship between MAC and stroke, but an independent association between AV calcification and cerebral infarction has only been demonstrated in the presence of AV stenosis. 5,10,11 MAC and AV sclerosis are associated with atherosclerosis risk factors that can promote left ventricular (LV) hypertrophy and left atrial (LA) enlargement, each of which has been reported to predict cerebrovascular events. 12,13 However, available studies linking valvular calcification with cerebral ischemia have adjusted only partly, if at all, for these concurrent echocardiographi...

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Risk of Stroke in a Cohort of 815 Patients With Calcification of the Aortic Valve With or Without Stenosis

Abstract: Aortic valve calcification with or without stenosis is not a risk factor for stroke.

Cited by 64 publications

References 36 publications

Stroke as the First Manifestation of Calcific Aortic Stenosis

Stroke as the First Manifestation of Calcific Aortic Stenosis

Stroke in Patients With Aortic Stenosis

Mitral Annular Calcification, Aortic Valve Sclerosis, and Incident Stroke in Adults Free of Clinical Cardiovascular Disease

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