Spring 2006


Kavian Ghandehari, Zahra Izadi Mood


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.
Key Words: Cardioembolic, stroke, rheumatic.

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