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Observational Study
. 2021 May 1;28(5):514-523.
doi: 10.5551/jat.56440. Epub 2020 Jul 17.

Atrial Septal Aneurysm may Cause In-Hospital Recurrence of Cryptogenic Stroke

Ayako Kuriki  1 , Yuji Ueno  2 , Yuki Kamiya  1 , Takahiro Shimizu  3 , Ryosuke Doijiri  4 , Yohei Tateishi  5 , Muneaki Kikuno  6 , Yoshiaki Shimada  7 , Hidehiro Takekawa  8 , Eriko Yamaguchi  4 , Masatoshi Koga  6 , Masafumi Ihara  9 , Kenjiro Ono  10 , Akira Tsujino  5 , Koichi Hirata  8 , Kazunori Toyoda  6 , Yasuhiro Hasegawa  3 , Nobutaka Hattori  2 , Takao Urabe  7
Affiliations
Observational Study

Atrial Septal Aneurysm may Cause In-Hospital Recurrence of Cryptogenic Stroke

Ayako Kuriki et al. J Atheroscler Thromb. .

Abstract

Aims: Awareness of potentially embologenic diseases is critical to determining the prognosis of cryptogenic stroke. The clinical significance of atrial septal aneurysm (ASA) in cryptogenic stroke has not been fully studied. Therefore, we explored clinical characteristics and in-hospital recurrence in patients with ASA in cryptogenic stroke.

Methods: A multicenter observational registry of cryptogenic stroke patients was conducted. We obtained baseline characteristics, radiological and laboratory findings, and echocardiographic findings, especially of embolic sources on transesophageal echocardiography. The CHALLENGE ESUS/CS (Mechanisms of Embolic Stroke Clarified by Transesophageal Echocardiography for embolic stroke of undetermined source/cryptogenic stroke) registry was recorded at http://www.umin.ac.jp/ctr/ (UMIN000032957). Patients' clinical characteristics were compared according to the presence of ASA, and factors associated with in-hospital stroke recurrence were assessed.

Results: The study included 671 patients (age, 68.7±12.7 years; 450 males; median National Institutes of Health Stroke Scale score, 2). ASA was detected in 92 patients (14%), displaying higher age (72.4±11.0 vs. 68.1 ±12.9 years, p=0.004), reduced frequency of diabetes mellitus (16% vs. 27%, p=0.030), higher frequency of right-to-left shunt (66% vs. 45%, p＜0.001), and in-hospital stroke recurrence (8% vs. 3%, p=0.034). ASA was relatively associated with in-hospital recurrence (odds ratio 2.497, 95% confidence interval 0.959-6.500, p= 0.061).

Conclusions: The CHALLENGE ESUS/CS registry indicated that ASA was not rare in cryptogenic stroke, and ASA's clinical characteristics included higher age, reduced frequency of diabetes mellitus, and increased frequency of concomitant right-to-left shunt. ASA may be related to in-hospital stroke recurrence in cryptogenic stroke.

Keywords: Atrial septal aneurysm; Cryptogenic stroke; Stroke; Transesophageal echocardiography.

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Figures

<b>Fig. 1.</b> Proportion of enrolled patients and frequency of atrial septal aneurysm
Fig. 1. Proportion of enrolled patients and frequency of atrial septal aneurysm
Histograms and line graphs show the number of enrolled patients and frequency of atrial septal aneurysm according to age.
See this image and copyright information in PMC

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