{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T16:52:36Z","timestamp":1776876756634,"version":"3.51.2"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[1997,8]]},"abstract":"<jats:p>\n            <jats:italic>Background and Purpose<\/jats:italic>\n            Strands are thin and filamentous attachments on the cardiac valves shown by transesophageal echocardiography. Their nature and their potential for embolization are largely unknown. The objective was to estimate the risk of brain infarction in patients with mitral valve strands.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Methods<\/jats:italic>\n            Using transesophageal echocardiography, we compared the frequency of strands on native mitral valves in 284 consecutive patients admitted with brain infarction and 276 control patients, all older than 60 years. In a second part, case subjects were followed up over a 2- to 4-year period, and the risk of recurrence of brain infarction was estimated in patients with and without strands.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Results<\/jats:italic>\n            In the case-control study, mitral valve strands were found in 22.5% of the case patients and in 12.1% of the control subjects. In case subjects, mitral valve strands were more frequent in those with mitral valve dystrophy (52.4% versus 37.4%;\n            <jats:italic>P<\/jats:italic>\n            =.03). Strands were not associated with mitral valve prolapse, annular calcifications, or left atrial spontaneous echocardiographic contrast. After adjustment for age, sex, and mitral valve dystrophy, the odds ratio for ischemic stroke among patients with mitral strands was 2.2 (95% confidence interval, 1.4 to 3.6;\n            <jats:italic>P<\/jats:italic>\n            =.005). The frequency of strands was not different in patients with a known cause of brain infarction (24.4%) from that in patients with no other apparent cause (20.9%). During 646 per 100 person-years of follow-up, the incidence of recurrent brain infarction was 6.0 person-years in patients with strands and 4.2 in those without. In the Cox analysis, including potential confounders and poststroke treatment, mitral valve strands did not appear as independent predictors of recurrent brain infarction (relative risk, 1.3; 95% confidence interval, 0.5 to 3.0;\n            <jats:italic>P<\/jats:italic>\n            =.54).\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Conclusions<\/jats:italic>\n            The present study shows an independent association between mitral valve strands and the risk of brain infarction. However, the lack of an increased relative risk of recurrence raises doubts about the potential causal relation with brain infarction in patients aged 60 years or older.\n          <\/jats:p>","DOI":"10.1161\/01.str.28.8.1574","type":"journal-article","created":{"date-parts":[[2011,6,17]],"date-time":"2011-06-17T20:08:03Z","timestamp":1308341283000},"page":"1574-1578","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":41,"title":["Mitral Valve Strands and the Risk of Ischemic Stroke in Elderly Patients"],"prefix":"10.1161","volume":"28","author":[{"given":"Ariel","family":"Cohen","sequence":"first","affiliation":[{"name":"From the Service de Cardiologie (A.C., C.C.) and Neurologie (C.T., I.C., M-G.B., P.A.), Ho\u0302pital Saint-Antoine, Universite\u0301 Pierre et Marie Curie, Paris; INSERM U 360 Recherches e\u0301pide\u0301miologiques en Neurologie et Psychopathologie, Ho\u0302pital de la Pitie\u0301-Salpe\u0301trie\u0300re (C.T.), Paris; and the Cliniques Cardiologiques des Centres Hospitaliers Universitaires de Grenoble (B.B.), Besanc\u0327on (Y.B.), Lille (L.G.), and Dijon (S.F.), France."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christophe","family":"Tzourio","sequence":"additional","affiliation":[{"name":"From the Service de Cardiologie (A.C., C.C.) and Neurologie (C.T., I.C., M-G.B., P.A.), Ho\u0302pital Saint-Antoine, Universite\u0301 Pierre et Marie Curie, Paris; INSERM U 360 Recherches e\u0301pide\u0301miologiques en Neurologie et Psychopathologie, Ho\u0302pital de la Pitie\u0301-Salpe\u0301trie\u0300re (C.T.), Paris; and the Cliniques Cardiologiques des Centres Hospitaliers Universitaires de Grenoble (B.B.), Besanc\u0327on (Y.B.), Lille (L.G.), and Dijon (S.F.), France."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christophe","family":"Chauvel","sequence":"additional","affiliation":[{"name":"From the Service de Cardiologie (A.C., C.C.) and Neurologie (C.T., I.C., M-G.B., P.A.), Ho\u0302pital Saint-Antoine, Universite\u0301 Pierre et Marie Curie, Paris; INSERM U 360 Recherches e\u0301pide\u0301miologiques en Neurologie et Psychopathologie, Ho\u0302pital de la Pitie\u0301-Salpe\u0301trie\u0300re (C.T.), Paris; and the Cliniques Cardiologiques des Centres Hospitaliers Universitaires de Grenoble (B.B.), Besanc\u0327on (Y.B.), Lille (L.G.), and Dijon (S.F.), France."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernard","family":"Bertrand","sequence":"additional","affiliation":[{"name":"From the Service de Cardiologie (A.C., C.C.) and Neurologie (C.T., I.C., M-G.B., P.A.), Ho\u0302pital Saint-Antoine, Universite\u0301 Pierre et Marie Curie, Paris; INSERM U 360 Recherches e\u0301pide\u0301miologiques en Neurologie et Psychopathologie, Ho\u0302pital de la Pitie\u0301-Salpe\u0301trie\u0300re (C.T.), Paris; and the Cliniques Cardiologiques des Centres Hospitaliers Universitaires de Grenoble (B.B.), Besanc\u0327on (Y.B.), Lille (L.G.), and Dijon (S.F.), France."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabelle","family":"Crassard","sequence":"additional","affiliation":[{"name":"From the Service de Cardiologie (A.C., C.C.) and Neurologie (C.T., I.C., M-G.B., P.A.), Ho\u0302pital Saint-Antoine, Universite\u0301 Pierre et Marie Curie, Paris; INSERM U 360 Recherches e\u0301pide\u0301miologiques en Neurologie et Psychopathologie, Ho\u0302pital de la Pitie\u0301-Salpe\u0301trie\u0300re (C.T.), Paris; and the Cliniques Cardiologiques des Centres Hospitaliers Universitaires de Grenoble (B.B.), Besanc\u0327on (Y.B.), Lille (L.G.), and Dijon (S.F.), France."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yvette","family":"Bernard","sequence":"additional","affiliation":[{"name":"From the Service de Cardiologie (A.C., C.C.) and Neurologie (C.T., I.C., M-G.B., P.A.), Ho\u0302pital Saint-Antoine, Universite\u0301 Pierre et Marie Curie, Paris; INSERM U 360 Recherches e\u0301pide\u0301miologiques en Neurologie et Psychopathologie, Ho\u0302pital de la Pitie\u0301-Salpe\u0301trie\u0300re (C.T.), Paris; and the Cliniques Cardiologiques des Centres Hospitaliers Universitaires de Grenoble (B.B.), Besanc\u0327on (Y.B.), Lille (L.G.), and Dijon (S.F.), France."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luc","family":"Goullard","sequence":"additional","affiliation":[{"name":"From the Service de Cardiologie (A.C., C.C.) and Neurologie (C.T., I.C., M-G.B., P.A.), Ho\u0302pital Saint-Antoine, Universite\u0301 Pierre et Marie Curie, Paris; INSERM U 360 Recherches e\u0301pide\u0301miologiques en Neurologie et Psychopathologie, Ho\u0302pital de la Pitie\u0301-Salpe\u0301trie\u0300re (C.T.), Paris; and the Cliniques Cardiologiques des Centres Hospitaliers Universitaires de Grenoble (B.B.), Besanc\u0327on (Y.B.), Lille (L.G.), and Dijon (S.F.), France."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sylvie","family":"Falcon","sequence":"additional","affiliation":[{"name":"From the Service de Cardiologie (A.C., C.C.) and Neurologie (C.T., I.C., M-G.B., P.A.), Ho\u0302pital Saint-Antoine, Universite\u0301 Pierre et Marie Curie, Paris; INSERM U 360 Recherches e\u0301pide\u0301miologiques en Neurologie et Psychopathologie, Ho\u0302pital de la Pitie\u0301-Salpe\u0301trie\u0300re (C.T.), Paris; and the Cliniques Cardiologiques des Centres Hospitaliers Universitaires de Grenoble (B.B.), Besanc\u0327on (Y.B.), Lille (L.G.), and Dijon (S.F.), France."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie-Germaine","family":"Bousser","sequence":"additional","affiliation":[{"name":"From the Service de Cardiologie (A.C., C.C.) and Neurologie (C.T., I.C., M-G.B., P.A.), Ho\u0302pital Saint-Antoine, Universite\u0301 Pierre et Marie Curie, Paris; INSERM U 360 Recherches e\u0301pide\u0301miologiques en Neurologie et Psychopathologie, Ho\u0302pital de la Pitie\u0301-Salpe\u0301trie\u0300re (C.T.), Paris; and the Cliniques Cardiologiques des Centres Hospitaliers Universitaires de Grenoble (B.B.), Besanc\u0327on (Y.B.), Lille (L.G.), and Dijon (S.F.), France."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierre","family":"Amarenco","sequence":"additional","affiliation":[{"name":"From the Service de Cardiologie (A.C., C.C.) and Neurologie (C.T., I.C., M-G.B., P.A.), Ho\u0302pital Saint-Antoine, Universite\u0301 Pierre et Marie Curie, Paris; INSERM U 360 Recherches e\u0301pide\u0301miologiques en Neurologie et Psychopathologie, Ho\u0302pital de la Pitie\u0301-Salpe\u0301trie\u0300re (C.T.), Paris; and the Cliniques Cardiologiques des Centres Hospitaliers Universitaires de Grenoble (B.B.), Besanc\u0327on (Y.B.), Lille (L.G.), and Dijon (S.F.), France."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_1_2","first-page":"244","volume":"6","year":"1856","unstructured":"Lambl VA. 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Small abnormal echos after mitral valve replacement with bileaflet mechanical prostheses: predisposing factors and effect on thromboembolism. J Heart Valve Dis. 1993;2:259-266.","journal-title":"J Heart Valve Dis"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(95)00375-4"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199505113321906"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/clc.4960040112"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(86)90063-X"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-6196(11)63944-X"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199412013312202"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/str.25.1.8266377"},{"key":"e_1_3_2_15_2","first-page":"345","volume":"88","year":"1995","unstructured":"Benhalima B, Cohen A, Chauvel C, Abergel E, Albo C, Elhadad S, Hobeiche M, Khireddine M, Rozensztajn L, Valty J. Etude morphologique par \u00e9chocardiographie transoesophagienne et aspects cliniques de la rupture de cordages mitral chez le sujet \u00e2g\u00e9. Arch Mal Coeur. 1995;88:345-352.","journal-title":"Arch Mal Coeur"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199208063270602"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199605093341902"},{"key":"e_1_3_2_18_2","unstructured":"Breslow NE Day NE. The Analysis of Case-Control Studies. Lyon France: International Agency for Research in Cancer; 1980:1. Statistical Methods in Cancer Research."},{"key":"e_1_3_2_19_2","unstructured":"SAS User\u2019s Guide: Volume 1 Version 6. 4th ed. Cary NC: SAS Institute Inc; 1994."},{"key":"e_1_3_2_20_2","unstructured":"BMDP Statistical Software Manual. New York NY: John Wiley & Sons Ltd; 1992."},{"key":"e_1_3_2_21_2","unstructured":"Schlesselman JJ. Case-Control Studies: Design Conduct Analysis. 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