Prevalence of potential risk factors for stroke assessed by transesophageal echocardiography and carotid ultrasonography: the SPARC study. Stroke Prevention: Assessment of Risk in a Community.

OBJECTIVE The SPARC (Stroke Prevention: Assessment of Risk in a Community) study was designed to identify risk factors for stroke and cardiovascular disease using transesophageal echocardiography and carotid ultrasonography. This protocol was undertaken to establish a cohort in which putative risk factors for stroke were identified so that subsequent follow-up could discern the roles these risk factors play in stroke incidence. SUBJECTS AND METHODS This was a prospective, population-based study. A randomly selected cohort comprised 1475 Olmsted County, Minnesota, residents aged 45 years or older, of whom 588 agreed to participate. Transesophageal echocardiography and carotid ultrasonography were used for evaluation of the subjects. Prevalences of various cardiovascular and cerebrovascular conditions were determined. RESULTS Transesophageal echocardiography was successfully completed in 581 subjects. The prevalence (+/-SE) of patent foramen ovale was 25.6% (+/-1.9%), and that of atrial septal aneurysm was 2.2% (+/-0.6%). The prevalence of aortic atherosclerosis increased with age and was most common in the descending aorta, particularly in subjects 75 to 84 years old. The prevalence of strands on native valve was 46.4% (+/-2.2%). Carotid ultrasonography data for 567 participants revealed minimal atherosclerotic disease. Most subjects had minimal or mild carotid occlusive disease. The prevalence of moderate (50%-79%) and severe (80%-99%) stenosis was 7.7% (+/-1.1%) and 0.3% (+/-0.2 %), respectively. CONCLUSIONS This prospective study defines the prevalence of multiple potential cardiovascular and cerebrovascular risk factors, providing population-based data for ongoing follow-up of the risk of stroke.

[1]  L. Melton,et al.  Comparison of case ascertainment by medical record linkage and cohort follow-up to determine incidence rates for transient ischemic attacks and stroke. , 1990, Journal of clinical epidemiology.

[2]  I. Kronzon,et al.  Valve strands are strongly associated with systemic embolization: a transesophageal echocardiographic study. , 1995, Journal of the American College of Cardiology.

[3]  A. Labovitz,et al.  Superiority of transesophageal echocardiography in detecting cardiac source of embolism in patients with cerebral ischemia of uncertain etiology. , 1991, Journal of the American College of Cardiology.

[4]  R. Sacco,et al.  Characteristics of Patent Foramen Ovale Associated With Cryptogenic Stroke: A Biplane Transesophageal Echocardiographic Study , 1994, Stroke.

[5]  M. Hommel,et al.  Atherosclerotic disease of the aortic arch and the risk of ischemic stroke. , 1994, The New England journal of medicine.

[6]  W M O'Fallon,et al.  The natural history of asymptomatic carotid artery occlusive lesions. , 1987, JAMA.

[7]  T. Welch,et al.  Current applications of duplex and color Doppler ultrasound imaging: carotid and peripheral vascular system. , 1989, Mayo Clinic proceedings.

[8]  D. Strandness,et al.  Carotid artery duplex scanning , 1987, Journal of clinical ultrasound : JCU.

[9]  S. Olsson,et al.  Potential cardioembolic sources in an elderly population without stroke. A transthoracic and transoesophageal echocardiographic study in randomly selected volunteers. , 1996, European heart journal.

[10]  O. Godefroy,et al.  Higher prevalence of atrial septal aneurysms in patients with ischemic stroke of unknown cause , 1994, Acta neurologica Scandinavica.

[11]  S. Smazal,et al.  Duplex sonography in the evaluation of carotid artery disease. , 1983, AJNR. American journal of neuroradiology.

[12]  W. O'Fallon,et al.  Prospective comparison of a cohort with asymptomatic carotid bruit and a population-based cohort without carotid bruit. , 1990, Stroke.

[13]  T. Riles,et al.  Comparison of Magnetic Resonance Angiography, Conventional Angiography, and Duplex Scanning , 1992, Stroke.

[14]  R. Popp,et al.  Transesophageal Echocardiography in the Evaluation of Stroke , 1992, Annals of Internal Medicine.

[15]  W. Edwards,et al.  Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. , 1984, Mayo Clinic proceedings.

[16]  Michael Witt,et al.  SUDAAN User's Manual, Release 9.0 , 2002 .

[17]  L. Wann,et al.  Prevalence of right-to-left atrial shunting in a healthy population: detection by Valsalva maneuver contrast echocardiography. , 1984, The American journal of cardiology.

[18]  R. Sacco,et al.  Patent Foramen Ovale as a Risk Factor for Cryptogenic Stroke , 1992, Annals of Internal Medicine.

[19]  A. Slivka,et al.  Mitral valve strands in patients with focal cerebral ischemia. , 1996, Stroke.

[20]  J. Bogousslavsky,et al.  Stroke recurrence in patients with patent foramen ovale , 1996, Neurology.

[21]  J. Thomas,et al.  Selection of patients for transesophageal echocardiography after stroke and systemic embolic events. Role of transthoracic echocardiography. , 1995, Stroke.

[22]  D. E. Strandness,et al.  Duplex scanning in vascular disorders , 1990 .

[23]  J. Ross,et al.  Recognition and embolic potential of intraaortic atherosclerotic debris. , 1991, Journal of the American College of Cardiology.

[24]  L. Melton,et al.  History of the Rochester Epidemiology Project. , 1996, Mayo Clinic proceedings.

[25]  H. J. Smith,et al.  PATENT FORAMEN OVALE IN YOUNG STROKE PATIENTS , 1988, The Lancet.

[26]  A. Tonkin,et al.  Evidence that patent foramen ovale is not a risk factor for cerebral ischemia in the elderly. , 1994, The American journal of cardiology.

[27]  T. Meinertz,et al.  Echocardiographic evaluation of patients with clinically suspected arterial emboli , 1990, The Lancet.

[28]  P. Lechat,et al.  Prevalence of patent foramen ovale in patients with stroke. , 1988, The New England journal of medicine.

[29]  A. Camm,et al.  Risk of patent foramen ovale for thromboembolic events in all age groups. , 1992, The American journal of cardiology.

[30]  E. Ringelstein,et al.  Comparison of transcranial contrast Doppler sonography and transesophageal contrast echocardiography for the detection of patent foramen ovale in young stroke patients. , 1994, The American journal of cardiology.

[31]  B K Khandheria,et al.  Biplanar transesophageal echocardiography: anatomic correlations, image orientation, and clinical applications. , 1990, Mayo Clinic proceedings.

[32]  W. Stewart,et al.  Patent Foramen Ovale and Brain Infarct: Echocardiographic Predictors, Recurrence, and Prevention , 1994, Stroke.

[33]  I. Schnittger,et al.  Enhanced detection of intracardiac sources of cerebral emboli by transesophageal echocardiography. , 1991, Stroke.

[34]  M. Enriquez-Sarano,et al.  Multiplane transesophageal echocardiography: image orientation, examination technique, anatomic correlations, and clinical applications. , 1993, Mayo Clinic proceedings.

[35]  J. Seward,et al.  Diagnosis and classification of atrial septal aneurysm by two-dimensional echocardiography: report of 80 consecutive cases. , 1985, Journal of the American College of Cardiology.

[36]  B Barnwell,et al.  SUDAAN User's Manual, Release 7.5, , 1997 .

[37]  F. Pinto,et al.  Biplane transesophageal echocardiography in the diagnosis of patent foramen ovale. , 1993, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[38]  A. Tonkin,et al.  Proximal aortic atheroma. An independent risk factor for cerebral ischemia. , 1995, Stroke.

[39]  F. Chédru,et al.  Atrial Septal Aneurysm and Patent Foramen Ovale as Risk Factors for Cryptogenic Stroke in Patients Less Than 55 Years of Age: A Study Using Transesophageal Echocardiography , 1993, Stroke.