A Comparison of Infarct Size and Prognosis between Cardiogenic Embolic Infarction and Large Artery Atherosclerotic Infarction

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1 A Comparison of Infarct Size and Prognosis between Cardiogenic Embolic Infarction and Large Artery Atherosclerotic Infarction Ji-Hoon Jang, M.D., Byung-Woo Yoon, M.D.*, Jae-Kyu Roh, M.D.* Department of Neurology, Cheju Hanmaeum Hospital Department of Neurology, College of Medicine, Seoul National University*, Neuroscience Research Institute, SNUMRC Background : Cardiogenic embolic infarction is the most preventable type of ischemic stroke. This study was undertaken to compare the infarct size, prognosis, and risk factors between cardiogenic embolic infarction (CE) and large artery atherosclerotic infarction (LAA). M e t h o d s : We reviewed the medical records and brain computed tomography/magnetic resonance image (CT/MRI) scans of patients with CE or LAA during the period between January 1996 and May Patients with lacunar and posterior circulation infarctions were excluded. A slice of brain CT/MRI scan showing the largest lesion was selected in each patient and the area of infarction was then measured. Prognosis was determined by the Modified Rankin Disability Scale (MRDS) and was grouped as either good (MDRS 0, 1, 2) or poor (MDRS 3, 4, 5). Results : The study included 103 patients : 50 with CE (NVAF in 23, VHD with or without AF in 13, prosthetic valve in 6, and others in 8) and 53 with LAA (large artery thrombosis in 29, and artery to artery embolism in 24). The infarct size of CE (23.2±14.7 cm 2 ) was significantly larger than that of LAA (11.4±10.5 cm 2 ) (p<0.001). The infarct size of NVAF (29.0±19.1 cm 2 ) was significantly larger than that of VHD with or without AF (19.2±11.5 cm 2 ) (p<0.05). Patients with CE had a worse prognosis (poor in 46%) than those with LAA (poor in 23%) (p<0.05). C o n c l u s i o n s : Our results showed that CE led to larger lesions and worse outcomes. Therefore, we emphasize the importance of primary and secondary preventions of stroke in patients with cardiogenic embolic sources. J Korean Neurol Assoc 18(4):381~385, 2000 Key Words : Cardiogenic embolic infarction, Large artery atherosclerotic infarction, Nonvalvular atrial fibrillation, Valvular heart disease, Infarct size, Prognosis Byung-Woo Yoon, M.D. Copyright 2000 by the Korean Neurological Association 381

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3 Table 1. Comparison between CE and LAA patients Factors CE(N=50) LAA(N=53) p value Male 27(54.0%) 42(79.2%) <0.01 Mean agesd(yr) 57.4± ±12.4 <0.05 Smoking 13(26.0%) 31(58.4%) <0.001 Infarct size(cm 2 ) 23.2± ±10.5 <0.001 Poor prognosis 23(46.0%) 12(23.0%) <0.05 LA size(mm) 49.6± ±6.4 <0.001 LV EF(%) 51.7± ±8.4 <0.001 hypercholesterolemia, diabetes mellitus, hematocrit, hypertension ; p >0.05 CE; cardioembolism, LAA; large artery atherosclerosis LA; left atrium, LV; left ventricle, EF; ejection fraction Table 2. Comparison between patients with NVAF and VHD with/without AF Factors NVAF(N=23) VHD±AF(N=13) p value Male 15(65.2%) 5(38.5%) NS Mean agesd(yr) 65.0± ±14.3 <0.01 Smoking 16(69.6%) 5(38.5%) <0.01 Infarct size(cm 2 ) 29.0± ±11.5 <0.01 Poor prognosis 14(60.9%) 6(46.2%) NS LA size(mm) 50.1± ±10.9 NS LV EF(%) 48.8± ±7.7 NS hypercholesterolemia, diabetes mellitus, hematocrit, hypertension ; p >0.05 NVAF; nonvalvular atrial fibrillation, VHD; valvular heart disease, AF; atrial fibrillation LA; left atrium, LV; left ventricle, EF; ejection fraction J Korean Neurol Assoc / Volume 18 / July,

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