RESUMO
Coronary artery disease is a recognized risk factor for symptomatic ischaemic stroke but the influence on asymptomatic stroke has not been clearly determined. The purpose of this work was to determine the relationship between coronary heart disease and silent brain infarcts and the influence of vascular risk factors and carotid atherosclerosis in a representative sample of Spanish patients with symptomatic coronary artery disease. A consecutive sample of 100 subjects with myocardial infarction, angina or both were included in the survey. Patients with a potential source of emboli from the heart were excluded. As main baseline variables, we considered vascular risk factors; complete cardiological study, including coronary angiography; brain computed tomography (CT) to detect infarcts; echo-Doppler of supra-aortic vessels to detect stenosis; and carotid angiography, when appropriate. As the outcome variable, we observed the incidence of symptomatic stroke after an 18 month mean follow-up. We found silent brain infarction in 30 patients (93% were of lacunar type). None of the vascular risk factors was related to brain infarcts either in univariate or multivariate analysis. Carotid atherosclerosis was the only significant predictor in a model of logistic regression (P < 0.0005), although the lesions were bilateral in the majority of cases. We observed a very low incidence of symptomatic stroke after a mean follow-up of 18 months. Silent brain infarcts are a frequent finding on brain CT in patients with coronary heart disease and are associated with carotid atherosclerosis; however, it does not seem to have important prognostic significance.
Assuntos
Infarto Cerebral/etiologia , Doença das Coronárias/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Estenose das Carótidas/complicações , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/epidemiologia , Estudos Transversais , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Análise de Regressão , Fatores de Risco , Espanha/epidemiologia , Tomografia Computadorizada por Raios XRESUMO
A biatrial myxoma was diagnosed by 2D echocardiography in a man who was minimally symptomatic. Five years previously another similar tumour, located in the left atrium, attached to the interatrial septum, was excised. Similar histological features were present in both cases. The rarity of biatrial recurrence of this sort of myxoma is emphasized.