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Frequency of Atrial Septal Aneurysms in Patients with Cerebral Ischemic EventsBackground-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.
Document ID
20090004587
Acquisition Source
Headquarters
Document Type
Reprint (Version printed in journal)
Authors
Agmon, Yoram
(Mayo Clinic Rochester, MN, United States)
Khandheria, Bijoy K.
(Mayo Clinic Rochester, MN, United States)
Meissner, Irene
(Mayo Clinic Rochester, MN, United States)
Gentile, Federico
(Mayo Clinic Rochester, MN, United States)
Whisnant, Jack P.
(Mayo Clinic Rochester, MN, United States)
Sicks, JoRean D.
(Mayo Clinic Rochester, MN, United States)
O'Fallon, W. Michael
(Mayo Clinic Rochester, MN, United States)
Covalt, Jody L.
(Mayo Clinic Rochester, MN, United States)
Wiebers, David O.
(Mayo Clinic Rochester, MN, United States)
Seward, James B.
(Mayo Clinic Rochester, MN, United States)
Date Acquired
August 24, 2013
Publication Date
January 1, 1999
Publication Information
Publication: American Heart Association Journal
Publisher: American Heart Association
Volume: 99
Subject Category
Life Sciences (General)
Funding Number(s)
CONTRACT_GRANT: NIH NS-06663
Distribution Limits
Public
Copyright
Other

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