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. 2024 Jun 3;14(1):12656.
doi: 10.1038/s41598-024-60294-1.

Prognosis of ischemic stroke patients with both aortic atheroma and cardioembolic sources

Jae Wook Jung  1 , Minyoul Baik  2 , JaeWook Jeong  1 , Il Hyung Lee  1 , Kwang Hyun Kim  1 , Jaeseob Yun  1 , Chi Young Shim  3 , Geu-Ru Hong  3 , Young Dae Kim  1 , Ji Hoe Heo  1 , Hyo Suk Nam  4
Affiliations

Prognosis of ischemic stroke patients with both aortic atheroma and cardioembolic sources

Jae Wook Jung et al. Sci Rep. .

Abstract

This study aimed to investigate the relationship between complex aortic plaque (CAP) and short-term as well as long-term outcomes following cardioembolic stroke. CAP is a known risk factor for occurrence and recurrence of ischemic stroke. However, the association of CAP on cardioembolic stroke remains unclear. This was retrospective study using prospective cohort of consecutive patients with cardioembolic stroke who underwent transesophageal echocardiography. The functional outcome was evaluated using the modified Rankin Scale score at 3 months, and long-term outcomes were assessed by recurrence of ischemic stroke and occurrence of major adverse cardiovascular events (MACE). Among 759 patients with cardioembolic stroke, 91 (12.0%) had CAP. Early ischemic stroke recurrence within 3 months was associated with CAP (p = 0.025), whereas CAP was not associated with functional outcome at 3 months (odd ratio 1.01, 95% confidence interval [CI] 0.57-1.84, p = 0.973). During a median follow-up of 3.02 years, CAP was significantly associated with ischemic stroke recurrence (hazard ratio = 2.68, 95% CI 1.48-4.88, p = 0.001) and MACE occurrence (hazard ratio = 1.61, 95% CI 1.03-2.51, p = 0.039). In conclusion, CAP was associated with early ischemic stroke recurrence and poor long-term outcomes in patients with cardioembolic stroke. It might be helpful to consider transesophageal echocardiography for patients with cardioembolic stroke to identify CAP.

Keywords: Aortic atheroma; Cardioembolic stroke; Prognosis; Transesophageal echocardiography.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Cumulative incidence of ischemic stroke recurrence stratified by the presence of CAP (A) and distribution of modified Rankin Scale at 3 months according to the presence of CAP (B) Cumulative curves of ischemic stroke recurrence from index stroke to 90 days stratified by presence of CAP (A). Percent distribution of modified Rankin Scale at 3 months (B). IS: ischemic stroke; CAP: complex aortic plaque.
Figure 2
Figure 2
Long-Term Outcomes according to the presence of AA or CAP Cumulative recurrence of ischemic stroke according to the presence of AA (A), cumulative occurrence of MACE according to the presence of AA (B), cumulative recurrence of ischemic stroke according to the presence of CAP (C), and cumulative occurrence of MACE according to the presence of CAP (D). AA: aortic atheroma; CAP: complex aortic plaque; IS: ischemic stroke; MACE: major adverse cardiovascular event.
Figure 3
Figure 3
Antithrombotic drugs and long-term outcomes in patients with CAP Cumulative recurrence of ischemic stroke according to the antithrombotic drugs (A) and cumulative occurrence of MACE according to the antithrombotic drug (B). CAP: complex aortic plaque; IS: ischemic stroke; MACE: major adverse cardiovascular event.
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