Background. Stroke is a leading cause of mortality and disability in Brazil and around the world. Cardioembolism is responsible for nearly 30% of the origins of ischemic stroke. Methods. We analyzed data of 256 patients with cardioembolic ischemic stroke (according to TOAST classification) who were admitted into the Hospital S?o Lucas-PUCRS from October 2011 to January 2014. The cardioembolic subtype was divided into six subgroups: arrhythmias, valvular heart disease, coronary artery disease, cardiomyopathy, septal abnormalities, and intracardiac injuries. The prevalence of the most important cardiovascular risk factors and medications in use for prevention of systemic embolism by the time of hospital admission was analyzed in each patient. Results. Among 256 patients aged 60.2 +/? 6.9 years, 132 males, arrhythmias were the most common cause of cardioembolism corresponding to 50.7%, followed by valvular heart disease (17.5%) and coronary artery disease (16%). Hypertension (61.7%) and dyslipidemia (43.7%) were the most common risk factors. Less than 50% of patients with arrhythmias were using oral anticoagulants. Conclusions. Identifying the prevalence of cardioembolic stroke sources subgroups has become an increasingly important role since the introduction of new oral anticoagulants. In this study, arrhythmias (especially atrial fibrillation) were the main cause of cardioembolism. 1. Introduction Stroke is the leading cause of mortality and disability in Brazil and South America. However, there is little knowledge about stroke epidemiology, stroke subtypes, and risk factors in Latin America [1–3]. Basically strokes can be divided into ischemic (85%) and hemorrhagic (15%). The clinical characteristics of stroke vary according to etiology and risk factors. To facilitate and standardize the classification of stroke subtypes, it was developed in 1993—the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification which divides the ischemic stroke into five subtypes: large-artery atherosclerosis, cardioembolism, small-vessel occlusion, stroke of other determined etiology, and stroke of undetermined etiology. Knowledge of the etiology of ischemic events is essential for correct treatment and secondary prevention to improve the best patient outcomes [4, 5]. In the south of Brazil, the most important source of ischemic stroke is large-artery atherosclerosis followed by cardioembolism and small-vessel disease. Cardioembolism is responsible for nearly 30% of the origins of ischemic stroke [2, 6, 7]. Cardioembolism can be subdivided into six subgroups:
References
[1]
L. C. Porcello Marrone, L. P. Diogo, F. M. de Oliveira et al., “Risk factors among stroke subtypes in Brazil,” Journal of Stroke and Cerebrovascular Diseases, vol. 22, no. 1, pp. 32–35, 2013.
[2]
J. J. F. de Carvalho, M. B. Alves, G. á. A. Viana et al., “Stroke epidemiology, patterns of management, and outcomes in Fortaleza, Brazil: a hospital-based multicenter prospective study,” Stroke, vol. 42, no. 12, pp. 3341–3346, 2011.
[3]
G. Saposnik and O. H. Del Brutto, “Stroke in South America: a systematic review of incidence, prevalence, and stroke subtypes,” Stroke, vol. 34, no. 9, pp. 2103–2107, 2003.
[4]
H. P. Adams Jr., B. H. Bendixen, L. J. Kappelle et al., “Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial,” Stroke, vol. 24, no. 1, pp. 35–41, 1993.
[5]
M. J. O’Donnell, X. Denis, L. Liu et al., “Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study,” The Lancet, vol. 376, no. 9735, pp. 112–123, 2010.
[6]
H. Ihle-Hansen, B. Thommessen, T. B. Wyller, K. Engedal, and B. Fure, “Risk factors for and incidence of subtypes of ischemic stroke,” Functional Neurology, vol. 27, no. 1, pp. 35–40, 2012.
[7]
L. R. Caplan, Caplan's Stroke: A Clinical Approach, Saunders Elsevier, Philadelphia, Pa, USA, 4th edition, 2009.
[8]
S. J. Connolly, M. D. Ezekowitz, S. Yusuf et al., “Dabigatran versus warfarin in patients with atrial fibrillation,” New England Journal of Medicine, vol. 361, no. 12, pp. 1139–1151, 2009.
[9]
P. Amarenco, J. Bogousslavsky, L. R. Caplan, G. A. Donnan, and M. G. Hennerici, “Classification of stroke subtypes,” Cerebrovascular Diseases, vol. 27, no. 5, pp. 493–501, 2009.
[10]
L. G. Stead, R. M. Gilmore, M. F. Bellolio et al., “Cardioembolic but not other stroke subtypes predict mortality independent of stroke severity at presentation,” Stroke Research and Treatment, vol. 2011, Article ID 281496, 5 pages, 2011.
[11]
J. M. Ferro, “Cardioembolic stroke: an update,” The Lancet Neurology, vol. 2, no. 3, pp. 177–188, 2003.
[12]
C. A. Molina, J. Montaner, S. Abilleira et al., “Timing of spontaneous recanalization and risk of hemorrhagic transformation in acute cardioembolic stroke,” Stroke, vol. 32, no. 5, pp. 1079–1084, 2001.
[13]
R. P. Capmany, A. Arboix, R. Casa?as-Mu?oz, and N. Anguera-Ferrando, “Specific cardiac disorders in 402 consecutive patients with ischaemic cardioembolic stroke,” International Journal of Cardiology, vol. 95, no. 2-3, pp. 129–134, 2004.
[14]
E. A. Bocchi, G. Guimar?es, F. Tarasoutshi, G. Spina, S. Mangini, and F. Bacal, “Cardiomyopathy, adult valve disease and heart failure in South America,” Heart, vol. 95, no. 3, pp. 181–189, 2009.
[15]
J. O. Dias Junior, M. O. da Costa Rocha, A. C. de Souza, et al., “Assessment of the source of ischemic cerebrovascular events in patients with Chagas disease,” International Journal of Cardiology, 2014.
[16]
F. J. Carod-Artal, “Policy implications of the changing epidemiology of chagas disease and stroke,” Stroke, vol. 44, no. 8, pp. 2356–2360, 2013.
[17]
F. J. Carod-Artal, J. O. Casanova Lanchipa, L. M. Cruz Ramírez et al., “Stroke subtypes and comorbidity among ischemic stroke patients in brasilia and cuenca: a brazilian-spanish cross-cultural study,” Journal of Stroke and Cerebrovascular Diseases, vol. 23, no. 1, pp. 140–147, 2014.
[18]
M. R. Patel, K. W. Mahaffey, J. Garg et al., “Rivaroxaban versus warfarin in nonvalvular atrial fibrillation,” New England Journal of Medicine, vol. 365, no. 10, pp. 883–891, 2011.
[19]
C. B. Granger, J. H. Alexander, J. J. V. McMurray, et al., “Apixaban versus warfarin in patients with atrial fibrillation,” The New England Journal of Medicine, vol. 365, no. 11, pp. 981–992, 2011.