scholarly journals LENGTH-OF-STAY AND DEMOGRAPHICS IN ACUTE ISCHEMIC STROKE WITH LEFT ATRIAL OR LEFT VENTRICULAR THROMBUS

2018 ◽  
Author(s):  
Jodi Dodds
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Acute Ischemic Stroke ◽  
Left Atrial ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
Ventricular Thrombus

scholarly journals Dabigatran Effect on Left Ventricular Thrombus in a Patient with Acute Ischemic Stroke

2015 ◽  
Vol 17 (3) ◽  
pp. 366-368 ◽  
Author(s):  
Kyuyoon Chung ◽  
Young Min Paek ◽  
Hye Jung Lee ◽  
Keun-Sik Hong
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
Ventricular Thrombus

scholarly journals Giant Left Ventricular Thrombus in a Patient with Acute Ischemic Stroke: A Case Report and Minireview

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Fan Ye ◽  
Burton V. Silverstein ◽  
Matheen A. Khuddus ◽  
Christopher L. Bray ◽  
Arthur C. Lee
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Medical History ◽  
Dual Antiplatelet Therapy ◽  
Anterior Wall ◽  
Left Ventricular ◽  
Interesting Case ◽  
Left Ventricular Thrombus ◽  
Significant Past Medical History ◽  
Ventricular Thrombus

A 56-year-old healthy male with no obvious risk factors or significant past medical history was admitted to the emergency room with acute ischemic stroke. On his transthoracic echocardiography (TTE), an extremely large thrombus was detected at the apex involving the distal anterior wall. The thrombus was predominantly adherent but with a mobile tip. The patient was subsequently managed with dual antiplatelet therapy. In this report, we present an interesting case of an acute ischemic stroke secondary to a giant left ventricular thrombus in a patient with no past significant cardiac or neurologic medical history.

scholarly journals Acute Ischemic Stroke in a Young Patient with Left Ventricular Thrombus Attributed to Doxorubicin Cardiomyopathy

2020 ◽  
Vol 12 (Suppl. 1) ◽  
pp. 178-182
Author(s):  
Eung-Joon Lee ◽  
Byung-Woo Yoon
Keyword(s):  
Adverse Effect ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Young Patient ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
Ventricular Contractility ◽  
Ventricular Thrombus ◽  
Cardiomyopathy Patient ◽  
Doxorubicin Cardiomyopathy

We report a case of acute middle cerebral territory ischemic infarction caused by left ventricular thrombus (LVT) in a doxorubicin cardiomyopathy patient. A major adverse effect of doxorubicin is cardiotoxicity. In doxorubicin cardiomyopathy, as the ventricular contractility decreases, LVT can occur and lead to systemic embolic events such as stroke.

Abstract P709: Risk Factors Associated With Atrial Fibrillation Detection by Mobile Cardiac Outpatient Telemetry Following Acute Ischemic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ovais Inamullah ◽  
Alec McConnell ◽  
Hussein Al-khalidi ◽  
Gerald S Bloomfield ◽  
Shreyansh Shah
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Patient Selection ◽  
Left Atrial ◽  
Cryptogenic Stroke ◽  
Left Ventricular ◽  
Stepwise Logistic Regression ◽  
Internal Diameter ◽  
Atrial Area

Background: Mobile Cardiac outpatient telemetry (MCOT) is often used for patients (pts) with cryptogenic ischemic stroke following hospital discharge to detect atrial fibrillation (AFib) but criteria for patient selection remains a subject of debate. Methods: We identified 297 pts hospitalized with acute ischemic stroke who had an inpatient transthoracic echocardiogram (TTE) and underwent MCOT upon discharge between 2016 and 2018 at a large academic comprehensive stroke center. Pts characteristics between AFib vs. no AFib were compared by Fisher’s exact test for categorical and Wilcoxon rank-sum test for continuous variables. A multivariable stepwise logistic regression model was developed to determine the predictors of AFib detection. Statistical hypotheses were tested as two-sided at 0.05 level of significance. Results: Of the 297 pts, AFib was detected in 24 (8.1%) on 30-day MCOT. Pts with AFib detected were older, white, and have had a larger left atrial area (Table). The final logistic model demonstrated that white race (vs. non-white) (OR 4.86, 1.53-15.41), left atrial area (OR 1.15, 1.05-1.25) and left ventricular internal diameter in diastole (OR 0.33, 0.16-0.67) were associated with AFib detection by MCOT. Conclusion: Although rates of AFib detection on 30-day MCOT post-discharge was low, there are important patient characteristics and TTE features that can improve patient selection. Further studies are needed to determine if this data can be used prospectively to clinically decide which pts with cryptogenic stroke should be given 30-day MCT to detect atrial fibrillation.

Abstract W P192: Echocardiographic findings in Acute Ischemic Stroke are Implicated in Specific Subtypes of Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jun Lee ◽  
Jung-Im Kwon ◽  
Na-Young Kim ◽  
Hyun-Du Noh
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Left Atrial ◽  
Demographic Data ◽  
Left Ventricular ◽  
Volume Index ◽  
Large Artery ◽  
Vessel Occlusion ◽  
Stroke Subtypes ◽  
Echocardiographic Findings

Background & Significance: Echocardiographic left ventricular hypertrophy (LVH) and left atrial enlargement (LAE) reflect mortality and morbidity from cardiovascular disease. We aimed to investigate the association between echocardiographic findings and stroke subtypes and its implication in acute ischemic stroke. Methods: We retrospectively reviewed the records of 1692 patients with acute ischemic stroke, who were admitted within 7 days after symptom onset. Stroke subtypes were categorized according to the SSS-TOAST classification. LVH was defined as left ventricular mass index (LVMI) >115 g/m2 in men and >95 g/m2 in women, and moderate to severe LAE was defined as left ventricular volume index (LAVi) ≥34 ml/m2 in both gender. The demographic data and echocardiographic findings [LVMI, LAVi, and left atrial anterior-posterior diameter (LAD) and presence of LVH or LAE] were compared in each stroke subtype. Results: A total of 1002 patients who were classified as patients with large-artery atherosclerosis (LAA, n=525), patients with cardioembolism (CE, n=296), and patients with small vessel occlusion (SVO, n=181) were included. Echocardiographic variables showed trends in which larger LVMI, LAD, and LAVi in CE group compared with two other groups. Multivariate analysis was performed as comparison with SVO after adjusting for age, gender, hyperlipidemia, diabetes mellitus, and history of smoking. LVH and LVMI were significant independent predictors of LAA (OR 1.6, 95%CI 1.0-2.5, p=0.04 in LVH and OR 1.1, 95%CI 1.0-1.2 by increased LVMI 10g/m2, p=0.036), and all of moderate-to-severe LAE, LVH, LVMI, LAD and LAVi were significant independent predictors of CE (OR 16.7, 95%CI 8.3-33.7, p<0.001 in LAE; OR 2.4, 95%CI 1.5-3.8, p<0.001 in LVH; OR 1.2, 95%CI 1.11-1.3 by increased LVMI 10g/m2, p<0.001; OR 1.2, 95%CI 1.1-1.2 by increased LAD 1 mm, p<0.001; OR 1.2, 95%CI 1.1-1.2 by increased LAVi 1 ml/m2, p<0.001). Conclusions: Our studies demonstrate echocardiographic LVMI, LAD and LAVi are linked to specific stroke subtypes even after adjusting for established cardiovascular risk. These results suggest that consideration of echocardiographic indices is helpful to understand the pathomechanism in the ischemic stroke.

scholarly journals Direct oral anticoagulant use in left ventricular thrombus

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Zafar Ali ◽  
Nicholas Isom ◽  
Tarun Dalia ◽  
Farhad Sami ◽  
Uzair Mahmood ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Ischemic Cardiomyopathy ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Significant Risk ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
Ventricular Thrombus ◽  
Peripheral Embolization ◽  
One Year

Abstract Left ventricular thrombus (LVT) is associated with a significant risk of ischemic stroke (IS) and peripheral embolization. Societal guidelines recommend the use of warfarin, with direct oral anticoagulants (DOACs) only for patients unable to tolerate warfarin. We studied the natural history of LVT with anticoagulation (AC) with emphasis on comparing warfarin and DOAC use. In this single center study, we identified patients with a confirmed LVT. Type and duration of anticoagulation, INR levels and clinical outcomes (bleeding, ischemic stroke or peripheral embolization, and thrombus resolution) were recorded. LVT was confirmed in a total of 110 patients. Mean age was 59 + 14 years. 79% were men. Underlying etiology was chronic ischemic cardiomyopathy in 58%, non-ischemic cardiomyopathy in 23%. AC was started in 96 (87%) patients. At 1 year follow up, 11 patients (10%) had a stroke while on any AC (2 had hemorrhagic stroke and 9 had IS). Of those with IS, 7 were on warfarin (71% of those had subtherapeutic INR) and 2 patients on DOACs had IS. The 1-year risk of any stroke was 15% in warfarin group (12% risk of ischemic stroke) compared to 6% in the DOACs group (p = 0.33). 37 (63%) patients on warfarin and 18 (53%) on DOACs had resolution of thrombus (p = 0.85). One-year risk of stroke with LVT is high (10%) even with AC. Most patients IS on warfarin had subtherapeutic INR. There was no statistical difference in stroke risk or rate of thrombus resolution between warfarin and DOACs treated patients.

Abstract 15803: Effectiveness of Direct Oral Anticoagulant versus Warfarin in the Treatment of Left Ventricular Thrombus

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nicholas Isom ◽  
Zafar Ali ◽  
Tarun Dalia ◽  
Farhad Sami ◽  
Uzair Mahmood ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Natural History ◽  
Ischemic Cardiomyopathy ◽  
Academic Medical Center ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
Ventricular Thrombus ◽  
Peripheral Embolization ◽  
One Year

Introduction: Left ventricular thrombus (LVT) is associated with a higher risk of ischemic stroke and peripheral embolization. Societal guidelines recommend the use of warfarin, with direct oral anticoagulants (DOACs) only for patients unable to tolerate warfarin. Data on natural history and thrombus resolution with anticoagulation (AC), especially with DOACs is scarce. We studied the natural history of LVT with AC with emphasis on comparing warfarin and DOACs use. Methods: This is a single center, retrospective study conducted in an academic medical center. We identified patients (echocardiogram, CT or MRI) with a confirmed LVT study who were followed at our center. Chart review was conducted to collect clinical information at presentation and on follow up. Type and duration of anticoagulation, INR levels and clinical outcomes (bleeding, ischemic stroke or peripheral embolization, mortality) were recorded. Thrombus resolution on follow up imaging was also recorded. Results: LVT was confirmed in a total of 110 patients. Mean age was 59±14 years. 79% were men. Underlying etiology was chronic ischemic cardiomyopathy in 58%, non-ischemic cardiomyopathy in 23%. AC was started in 96 (87%) patients (in remaining patients AC was thought to be contraindicated). Of those on long-term AC, 60 patients (63%) were treated with warfarin, 3 patients (3%) with enoxaparin and 32 patients (33%) with a DOACs. At one year follow up, 11 patients (10%) had a stroke while on any AC. Two of these patients had hemorrhagic stroke (both on warfarin) and 9 patients had ischemic stroke. Of those with ischemic stroke 7 were on warfarin and 2 patients on DOACs had ischemic strokes. Of those with ischemic stroke on warfarin, 71% had subtherapeutic INR. The 1-year risk of any stroke was 15% in warfarin group (12% risk of ischemic stroke) compared to 6% in the DOACs group (p= 0.33). Total of 55 (57%) of patient started on AC had resolution of thrombus. 37 (63%) patients on warfarin and 18 (53%) on DOACs had resolution of thrombus (p= 0.85). Conclusions: One year risk of stroke with LVT is high (10%) even with AC. Most patients with ischemic stroke on warfarin had subtherapeutic INR. There was no statistical difference in stroke risk or rate of thrombus resolution between warfarin and DOACs treated patients.

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