Author + information
- Received October 15, 2010
- Revision received October 27, 2010
- Accepted November 1, 2010
- Published online December 1, 2010.
- Aylin Tugcu, MD⁎,
- Kazue Okajima, MD⁎,
- Zhezhen Jin, PhD†,
- Tatjana Rundek, MD§,
- Shunichi Homma, MD⁎,
- Ralph L. Sacco, MD§∥,
- Mitchell S.V. Elkind, MD‡ and
- Marco R. Di Tullio, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Marco R. Di Tullio, Columbia University Medical Center, PH3-342, 622 West 168th Street, New York, New York 10032
Objectives We sought to assess the association between the presence of a septal pouch in the left atrium and ischemic stroke.
Background It has been suggested that the presence of a left septal pouch (LSP) may favor the stasis of blood and possibly result in thromboembolic complications. However, the embolic potential of an LSP is not known.
Methods The association between an LSP and risk of stroke was assessed using a population-based case-control study design. The presence of an LSP was assessed by transesophageal echocardiography in 187 patients >50 years of age with a first-ever ischemic stroke (96 men, mean age 70.6 ± 9.0 years) and in 157 control subjects matched to patients by age, sex, and race/ethnicity. The association between an LSP and risk of stroke was assessed after adjustment for other stroke risk factors.
Results Patients with LSPs were younger than control subjects (67.5 ± 9.1 years vs. 69.6 ± 8.8 years; p = 0.046), with a lower prevalence of hypertension (68.0% vs. 80.3%; p = 0.01). There were no differences in the prevalence of LSPs between stroke patients and control subjects (28.9% vs. 29.3%, respectively; p = 0.93). The subgroup of 69 patients (36.9%) with cryptogenic stroke showed a similar prevalence of LSPs (31.9% vs. 29.3%; p = 0.70). Multivariable analysis showed that the presence of an LSP was not associated with ischemic stroke (odds ratio: 1.09; 95% confidence interval: 0.64 to 1.85) or cryptogenic stroke (odds ratio: 1.41; 95% confidence interval: 0.71 to 2.78).
Conclusions This study does not demonstrate evidence of the association of the presence of an LSP with ischemic stroke or cryptogenic stroke. The stroke risk associated with LSPs requires further evaluation in the younger stroke populations. The cofactors that may turn an LSP from an innocent bystander to a causative mechanism for stroke remains to be elucidated.
The study was supported by R01 NS36286 from the National Institute of Neurological Disorders and Stroke (NINDS). Dr. Di Tullio was the recipient of a NINDS Mid-Career Award in Patient-Oriented Research (K24 NS02241). All other authors have reported that they have no relationships to disclose.
- Received October 15, 2010.
- Revision received October 27, 2010.
- Accepted November 1, 2010.
- American College of Cardiology Foundation