Association between Atrial Septal Aneurysm and Mitral Valve Prolapse in Patients with Recent Stroke and Normal Carotid Arteries.

Background. The association between mitral valve prolapse (MVP) and cryptogenic stroke is controversial. The Atrial Septal Aneurysm Multicenter Italian (ASA-MI) Study is a prospective multicenter study evaluating the prevalence of atrial septal aneurysm (ASA) in patients with a recent stroke and normal carotid arteries. The aim of the present research was to evaluate the frequency of ASA and its association with MVP in the stroke population and in the subgroup of young patients (< 55 years) included in the ASA-MI Study.Methods. The study group included 245 of the 606 patients referred for transesophageal echocardiography (168 men and 77 women, mean age 65.7 ± 21 years). All patients were selected on the basis of a recent episode of unexplained cerebral ischemia and were included in the study if they had normal carotid arteries. The control population included 245 patients (mean age 64.7 ± 23 years) who underwent transesophageal echocardiographic evaluation during the same period for indications other than cerebral ischemia. The subgroup of young patients (< 55 years) included 90 patients (61 men and 29 women, mean age 49 ± 5 years).Results. The prevalence of MVP was 18% (95% confidence interval 8 to 21%) in the stroke population and 15% (95% confidence interval 7 to 20%) in the control population (chi2 = 2.1, p = NS). The prevalence of MVP did not differ between young stroke patients (28.8%) and young controls (20%) (chi2 = 0.835, p = 0.3). MVP was not significantly associated with stroke. We found an association between ASA and MVP: there was a higher incidence of MVP in stroke patients with an ASA than in patients without stroke or an ASA (40.9 vs 25%, p < 0.05). There was also a higher frequency of MVP associated with ASA in the group of young patients than in all patients of the ASA-MI Study (28.8 vs18%, chi2 = 20.313, p < 0.001). Conclusions. We found an association between ASA and MVP in patients with recent stroke and this association bore a higher risk of cerebral events than in patients without these abnormalities.