Cardioembolic Strokes in Eastern Iran and the Importance of Rheumatic Valvular Disease.

Background: 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. Materials and 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 from June 2003 to June 2005. All patients underwent diagnostic work-up to determine stroke etiology according to clinical indications. Diagnosis and classification of stroke were made according to World Health Organization (WHO) criteria. Results: In 302 patients with stroke (mean age 66.78, SD: 14.36), 60 (20%) patients (mean age 65.61, SD: 17.48) had cardiac source of embolism (CSE). Rheumatic mitral stenosis was present in 28 (28/60; 46.6%) of these cardioembolic stroke patients. Atrial fibrillation was documented in 19 (67.8%) patients with mitral stenosis. The remaining 32 (32/60; 53.3%) cardioembolic stroke patients had other CSE. Among the latter group, 8 (25%) patients had non-valvular atrial fibrillation. In the entire group of CSE, there were a total of 30 patients who were candidates for anticoagulation, and among those, 14 (14/30; 46.6%) were anticoagulated, but only 6 (6/30; 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 prevention of cardioembolic stroke. [ABSTRACT FROM AUTHOR]