22. European Stroke Conference 384 Heart and brain ATRIAL FIBRILLATION IN YOUNG STROKE PATIENTS: DO WE UNDERESTIMATE ITS PREVALENCE? D. Prefasi-Gomar1, P. Martinez-Sanchez2, A. Rodriguez-Sanz3, B. Fuentes4, D. Filgueiras-Rama5, E. Diez-Tejedor6 Department of Neurology and Stroke Center. IdiPAZ Health Research Institute. La Paz Uni-versity Hospital. Autónoma of Madrid University, Madrid, SPAIN1, Department of Neurology and Stroke Center. IdiPAZ Health Research Institute. La Paz University Hospital. Autónoma of Madrid University, Madrid, SPAIN2, Department of Neurology and Stroke Center. IdiPAZ Health Research Institute. La Paz University Hospital. Autónoma of Madrid University, Madrid, SPAIN3, Department of Neurology and Stroke Center. IdiPAZ Health Research Institute. La Paz University Hospital. Autónoma of Madrid University, Madrid, SPAIN4, Department of Cardiology. Arrhythmia Unit. IdiPAZ Health Research Institute. La Paz University Hospital. Autónoma of Madrid Universi-ty, Madrid, SPAIN5, Department of Neurology and Stroke Center. IdiPAZ Health Research Institute. La Paz University Hospital. Autónoma of Madrid University, Madrid, SPAIN6 BACKGROUND: The prevalence of atrial fibrillation (AF) in young stroke patients has been little reported, and is considered an uncommon cause of ischemic stroke (IS). Our objective was to ana-lyze the prevalence of AF in IS patients up to 50 years of age and its relationship with stroke sever-ity and outcomes. METHODS: Prospective observational study of consecutive IS patients up to 50 years of age admitted to a stroke center during a five-year period (2007-2011). A complete cardiolo-gy study was performed with daily electrocardiogram (ECG) and cardiac monitoring for 72 hours as well as echocardiography. In cases of stroke of unknown etiology, a 24-hour Holter monitoring was performed, which was repeated as necessary. We analyzed baseline data, previously or newly diag-nosed AF, structural heart disease (SHD) (valvulopathy/cardiomyopathy), stroke severity on admis-sion measured by the NIHSS (moderate-severe stroke if NIHSS≥8) and 3-month outcomes accord-ing to the mRS (good outcome if mRS ≤2). AF was classified as associated with SHD (AF-SHD) and not associated with SHD (AF-NSHD). RESULTS: One hundred fifty-seven patients were in-cluded (mean age 43 years, 58.6% male). Fourteen subjects (8.9%) presented AF, 10 AF-SHD and 4 AF-NSHD. AF was previously known in 11 patients (7%): 9 AF-SHD and 2 AF-NSHD. The multi-variate analysis showed an independent association between AF and moderate-severe IS (OR 3.771, 95%CI: 1.182-12.028), although AF was not an independent prognostic factor. CONCLUSION: AF may be more common than expected in young patients with IS and is associated with increased NI-HSS 490 © 2013 S. Karger AG, Basel Scientific Programme scores. 385 Heart and brain YIELD OF HOLTER AND ECHOCARDIOGRAPHY IN THE SCREENING OF TIA L. Benavente1, S. Calleja2, J. Vega3, D. Larrosa4, M. Rico5, M. Para6, J. Pascual7 Hospital Universitario Central de Asturias, Oviedo, SPAIN1, Hospital Universitario Central de Asturias, Oviedo, SPAIN2, Hospital Universitario Central de Asturias, Oviedo, SPAIN3, Hospi-tal Universitario Central de Asturias, Oviedo, SPAIN4, Hospital Universitario Central de Asturias, Oviedo, SPAIN5, Hospital Universitario Central de Asturias, Oviedo, SPAIN6, Hospital Universitario Central de Asturias, Oviedo, SPAIN7 BACKGROUND. Transient ischemic attacks (TIA) entail a high risk of stroke recurrence. Atrial fibrillation (AF) causes one out five strokes, but it is frequently paroxysmal and undetected, with an increased risk of stroke. Our aim is to quantify the yield of Holter monitor and echocardiography for detection paroxysmal AF and other cardiogenic embolic sources in a TIA Unit. METHODS. TIA Unit is a bed in the Emergency Department, staffed by vascular neurologist. Pa-tients are admitted in the mentioned unit during <48h with a complete etiological study, including Holter monitoring in cases without known AF and echocardiography. Preventive treatment is insti-tuted in patients discharged to a high resolution Neurology consultation to review in <2 weeks and subsequent follow-up. RESULTS. For one year, 161 patients were attended, being admitted to the hospital 8.6%. Recur-rence at 90 days was of 0.6%. Mean follow-up was 18.14±8.02 months (0-34), total recurrence 6.3%, mainly with cardioembolic cases (70%): 40% recurred despite INR>2; 30% were diagnosed when the Holter was repeated during recurrence. Another 30% of recurrences remained cryptogenic. Holter monitoring and echocardiography were pathological in 42% and 37.8% of the cases. There were no complications derived from treatment. Three deaths were registered unrelated to the stroke or treatment. CONCLUSIONS. This model allows an early diagnosis and treatment of TIA, avoiding recurrences of stroke in a long term. It encourages the use of cardiological studies to minimize the undetermined etiology, since recurrences occur in case of unknown cardioembolic source. It also influences on treatment, without complications.
Karger_ESC London_2013
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