Artery Research

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Volume 22, Issue C, June 2018, Pages 68 - 78

Gender-differences in prevalence and outcome of ischemic stroke and promoting factors of atrial thrombi

Authors
Karsten Kellera, b, *, d, Martin Geyerb, d, Thomas Münzelb, a, c, Mir Abolfazl Ostadb
aCenter for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
bCenter for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
cGerman Center for Cardiovascular Research, Partner site Rhein-Main, Mainz, Germany
d

K.K. and M.G. contributed equally and should both be considered as first authors.

*Corresponding author. Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany. Fax: +0049 6131 17 8461. E-mail address: Karsten.Keller@unimedizin-mainz.de (K. Keller).
Corresponding Author
Karsten Keller
Received 23 March 2018, Revised 2 May 2018, Accepted 7 May 2018, Available Online 26 May 2018.
DOI
10.1016/j.artres.2018.05.004How to use a DOI?
Keywords
Ischemic stroke; Sex; LAA; Left atrial appendix; Gender; Atrial fibrillation; Mortality; Stroke
Abstract

Background: Ischemic stroke is an important cause of death and disability. However, data about gender-differences in stroke are controversial.

Methods: In the nationwide sample, male and female inpatients were selected by screening for ischemic stroke by ICD-Code(I63) and compared. In a second study, we performed a retrospective analysis of patients who underwent transesophageal echocardiography (TEE) and screened for gender specific associations between clinical and echocardiographic parameters and atrial thrombi formation.

Results: Males had a higher incidence of ischemic stroke than females (372 vs. 340 per 100,000 citizens) with a substantial age-depending increase. Percentage of stroke patients with atrial fibrillation/flutter (AF, 34.2% vs. 26.5%) and the case-fatality rate (9.4% vs. 7.1%) were higher in females. AF seems to aggravate stroke events. In the retrospective study, 227 patients were enrolled (87 females (38.3%)). Females were older (IQR 72.0 (72.0–79.0) vs. 66.5 (57.3–76.8) years, P = 0.013), showed smaller right atrial (RA) area and slower blood flow velocity in left atrial appendage (LAA) (41.2 (29.2–58.5) vs. 50.0 (34.3–67.1) cm*sec−1, P = 0.038). Promoting factors of atrial thrombi in both genders were lower blood-flow velocity in LAA, larger LAA diameters, higher CHA2DS2-VASc-score and heart failure. AF, larger atrial septal-lateral diameters and areas were associated with atrial thrombi especially in males.

Conclusions: Our study demonstrated gender-specific differences in ischemic stroke. Incidence of ischemic stroke was higher in males than in females increasing exponentially with growing age in both genders. Females had a higher case-fatality rate presumably due to higher rate of AF. Promoting factors of atrial thrombi differ especially regarding atrial volumes and blood flow velocity in the LAA.

Copyright
© 2018 Association for Research into Arterial Structure and Physiology. Published by Elsevier B.V. All rights reserved.
Open Access
This is an open access article distributed under the CC BY-NC license.

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<Previous Article In Issue
Journal
Artery Research
Volume-Issue
22 - C
Pages
68 - 78
Publication Date
2018/05/26
ISSN (Online)
1876-4401
ISSN (Print)
1872-9312
DOI
10.1016/j.artres.2018.05.004How to use a DOI?
Copyright
© 2018 Association for Research into Arterial Structure and Physiology. Published by Elsevier B.V. All rights reserved.
Open Access
This is an open access article distributed under the CC BY-NC license.

Cite this article

risenwbib
TY  - JOUR
AU  - Karsten Keller
AU  - Martin Geyer
AU  - Thomas Münzel
AU  - Mir Abolfazl Ostad
PY  - 2018
DA  - 2018/05/26
TI  - Gender-differences in prevalence and outcome of ischemic stroke and promoting factors of atrial thrombi
JO  - Artery Research
SP  - 68
EP  - 78
VL  - 22
IS  - C
SN  - 1876-4401
UR  - https://doi.org/10.1016/j.artres.2018.05.004
DO  - 10.1016/j.artres.2018.05.004
ID  - Keller2018
ER  -