CARDIAC SOURCES OF EMBOLISM IN IRANIAN STROKE PATIENTS

INTRODUCTION: Rheumatic valvular disease is a common complication of rheumatic fever in children in developing countries. Later in life, rheumatic valvular disease becomes an important modifiable risk factor of stroke. The incidence of rheumatic valvular disease and its complications are unknown in Iran. METHODS: This is a prospective study of 302 consecutive patients admitted to a tertiary care hospital in Iran, with a diagnosis of non-hemorrhagic stroke between June 2005 and June 2006. All patients underwent diagnostic workup to determine stroke etiology according to clinical indications. Diagnosis and classification of stroke was made based on the PIC criteria. RESULTS: In 302 patients with stroke (mean age: 66.78±14.36 years), 60 patients (20%) (mean age: 65.61±17.48 years) had cardiac sources of embolism (CSE). Rheumatic mitral stenosis was present in 28 (46.6%) of these patients. Atrial fibrillation was documented in 19 patients (67.8%) with rheumatic valvular disease. The remaining 32 patients (53.3%) had other CSE. In the latter group, 8 patients (25%) had non-valvular atrial fibrillation. In the entire group with CSE, a total of 30 patients were candidates for anticoagulation; among them, 14 (46.6%) were anticoagulated, but only 6 (20%) were within therapeutic range at the time of their stroke. CONCLUSIONS: Rheumatic valvular disease seems to be the most common CSE in Iran. Many patients with rheumatic or non-rheumatic CSE are not adequately managed for secondary prevention of cardioembolic stroke.