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Significance of high intensity transient signals in patients with bioprosthetic heart valves
S38
ABSTRACTS
sources of embolism were ruled out by extensive clinical work up. The sample volume of the multirange probe was placed either side of the stenotic area of the MCA. Results: Twenty-three (30%) of the stenoses were lowgrade, 18 (23%) moderate and 37 (47%) of the stenoses were severe. Thirty-seven (47%) of the stenoses were symptomatic and 41 (53%) were asymptomatic. St.&cient insonation of the pre- and poststenotic segment of the MCA was possible in 70 stenoses (90%). No MES could be detected during a total of 1740 min monitoring time, neither before, after, nor within the MCA stenoses. MES were also absent in the contralatera1 MCA. Conclusion: MES are not detectable in patients with chronic MCA stenoses of different degree. This result is independent of symptomatic and asymptomatic stenoses. These results are a hint that chronic MCA stenoses do not represent an embolic source.
platelet aggregability (P = 0.04). Peripheral vascular disease, aortic arteriosclerosis, coronary artery disease, increased internal carotid artery intlmal thickness, raised values of lipoprotein(a), low values of protein C and raised plasma viscosity were more wmmon in patients with HITS, but failed to reach statistical significance. No clinical embolic events occurred prior to discharge from hospital. Conclusions. These findings suggest that HITS are primarily associated with patient factors, that patients receiving bioprostheses are not immune from the phenomenon and that some form of interaction takes place between the prosthesis and patient factors in the generation of HITS.
P60 cl
D.G. Nabavi’, D. Georgiadis’, J. Stockmann’, S. Aratoi, M. Schneider’, M. Borggrefe2, E.B. Ringelsteinl. lDe-
Significance of high intensity transient signals in patients with bioprosthetic heart valves
P. Moreno de la Santa’, A. Ionescu’, J. Giddings3, A.G. ‘Department of Cardiac Fraser’, E.G. Butchart’. Surgery; 2Deparhent of Cardiology; 3Department of Haematology, UniversityHospital of Wales, Cardifi UK
Aim: To determine the prevalence and associations of high-intensity transient signals (HITS) in the middle cerebral artery using transcranial Doppler in patients with bioprosthetic valves. Methods: Twenty-nine patients with Carpentier-Edwards bioprostheses (4 porcine and 25 pericardial) in the aortic position were examined 1 or 2 days before, and 1 week after valve replacement, by insonating the middle cerebral artery bilaterally for periods of 30 min. Interpretable signals on both occasions were present in 26 patients who form the basis of this study. All patients were on warfarin postoperatively with an INR between 2.5 and 3.5 at 7 days. Results: Pre-operatively, 14% patients had HITS. Post-operatively this percentage rose to 28%. The mean number of post-operative HITS was 7.8/h (O-156). Sex, age, hypertension, size and type of the valve, preoperative HITS, previous history of cerebrovascular events and antiwagulation level had no influence on the prevalence and number of HITS post-operatively. HITS were associated with atrial fibrillation (P = 0.03), diabetes mellitus (P= 0.025), cigarette smoking (P = 0.003), raised fibrinogen levels (P = 0.03), and high
P61 0
Intracranial microemboli in patients with cardiomyopathy, left ventricular anemm and chronic atria1 fibrillation Clinical and hemorheokq#cal correlates
partments of Neurobgy; 2Department of Cardiology, Uniuersiv of Mihster, Germany
Background and purpose: Cardioembolic diseases account for 15% to 30% of all ischemic strokes (IS). Several of so far asymptomatic patients, additionally, show cerebral infarcts on brain imaging studies indicating chronic silent brain embolism. Transcranial Doppler sonography (TCD) has become an accepted method for detecting clinically silent microembolic signals (MES). We investigated the prevalence of MES in 3 distinct patients cohorts with potential embolic heart diseases and evaluated the relation to different clinical parameters and blood properties. Methods: A total of 142 patients with dilatative cardiomyopathy (DCM, n = 43), chronic atrial fibrillation left ventricular @F, n = 47), and postinfarction aneuryms (LVA, n = 52) were enrolled in this study. In each patient, a standardized questionaire, review of the medical records, and extended investigations to exclude other ‘competitive’ embolic disorders was performed. TCD monitorings for MES were performed for 30 min duration. Blood was drawn immediately after each monitoring to determine standard coagulation parameters as well as plasma viscosity, platelet reactivity and red cell aggregation. Results: MES were found in 11 patients (26%) with DCM, 13 (28%) with AF, and 26 patients (50%) with LVA. Single factor analysis revealed significantly higher
ABSTRACTS
sources of embolism were ruled out by extensive clinical work up. The sample volume of the multirange probe was placed either side of the stenotic area of the MCA. Results: Twenty-three (30%) of the stenoses were lowgrade, 18 (23%) moderate and 37 (47%) of the stenoses were severe. Thirty-seven (47%) of the stenoses were symptomatic and 41 (53%) were asymptomatic. St.&cient insonation of the pre- and poststenotic segment of the MCA was possible in 70 stenoses (90%). No MES could be detected during a total of 1740 min monitoring time, neither before, after, nor within the MCA stenoses. MES were also absent in the contralatera1 MCA. Conclusion: MES are not detectable in patients with chronic MCA stenoses of different degree. This result is independent of symptomatic and asymptomatic stenoses. These results are a hint that chronic MCA stenoses do not represent an embolic source.
platelet aggregability (P = 0.04). Peripheral vascular disease, aortic arteriosclerosis, coronary artery disease, increased internal carotid artery intlmal thickness, raised values of lipoprotein(a), low values of protein C and raised plasma viscosity were more wmmon in patients with HITS, but failed to reach statistical significance. No clinical embolic events occurred prior to discharge from hospital. Conclusions. These findings suggest that HITS are primarily associated with patient factors, that patients receiving bioprostheses are not immune from the phenomenon and that some form of interaction takes place between the prosthesis and patient factors in the generation of HITS.
P60 cl
D.G. Nabavi’, D. Georgiadis’, J. Stockmann’, S. Aratoi, M. Schneider’, M. Borggrefe2, E.B. Ringelsteinl. lDe-
Significance of high intensity transient signals in patients with bioprosthetic heart valves
P. Moreno de la Santa’, A. Ionescu’, J. Giddings3, A.G. ‘Department of Cardiac Fraser’, E.G. Butchart’. Surgery; 2Deparhent of Cardiology; 3Department of Haematology, UniversityHospital of Wales, Cardifi UK
Aim: To determine the prevalence and associations of high-intensity transient signals (HITS) in the middle cerebral artery using transcranial Doppler in patients with bioprosthetic valves. Methods: Twenty-nine patients with Carpentier-Edwards bioprostheses (4 porcine and 25 pericardial) in the aortic position were examined 1 or 2 days before, and 1 week after valve replacement, by insonating the middle cerebral artery bilaterally for periods of 30 min. Interpretable signals on both occasions were present in 26 patients who form the basis of this study. All patients were on warfarin postoperatively with an INR between 2.5 and 3.5 at 7 days. Results: Pre-operatively, 14% patients had HITS. Post-operatively this percentage rose to 28%. The mean number of post-operative HITS was 7.8/h (O-156). Sex, age, hypertension, size and type of the valve, preoperative HITS, previous history of cerebrovascular events and antiwagulation level had no influence on the prevalence and number of HITS post-operatively. HITS were associated with atrial fibrillation (P = 0.03), diabetes mellitus (P= 0.025), cigarette smoking (P = 0.003), raised fibrinogen levels (P = 0.03), and high
P61 0
Intracranial microemboli in patients with cardiomyopathy, left ventricular anemm and chronic atria1 fibrillation Clinical and hemorheokq#cal correlates
partments of Neurobgy; 2Department of Cardiology, Uniuersiv of Mihster, Germany
Background and purpose: Cardioembolic diseases account for 15% to 30% of all ischemic strokes (IS). Several of so far asymptomatic patients, additionally, show cerebral infarcts on brain imaging studies indicating chronic silent brain embolism. Transcranial Doppler sonography (TCD) has become an accepted method for detecting clinically silent microembolic signals (MES). We investigated the prevalence of MES in 3 distinct patients cohorts with potential embolic heart diseases and evaluated the relation to different clinical parameters and blood properties. Methods: A total of 142 patients with dilatative cardiomyopathy (DCM, n = 43), chronic atrial fibrillation left ventricular @F, n = 47), and postinfarction aneuryms (LVA, n = 52) were enrolled in this study. In each patient, a standardized questionaire, review of the medical records, and extended investigations to exclude other ‘competitive’ embolic disorders was performed. TCD monitorings for MES were performed for 30 min duration. Blood was drawn immediately after each monitoring to determine standard coagulation parameters as well as plasma viscosity, platelet reactivity and red cell aggregation. Results: MES were found in 11 patients (26%) with DCM, 13 (28%) with AF, and 26 patients (50%) with LVA. Single factor analysis revealed significantly higher