Outcome of Stroke Patients with Cancer and Nonbacterial Thrombotic Endocarditis
Background and Purpose Nonbacterial thrombotic endocarditis (NBTE) is a cause of stroke in cancer. However, clinical characteristics and outcomes in stroke patients with cancer-associated NBTE are not well known. Methods We included consecutive patients with stroke and active cancer over a 9-year pe...
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doaj-c52f1abd0c2746e4a253d352979858a52020-11-25T02:35:56ZengKorean Stroke SocietyJournal of Stroke2287-63912287-64052020-05-0122224525310.5853/jos.2020.00619321Outcome of Stroke Patients with Cancer and Nonbacterial Thrombotic EndocarditisJoonsang Yoo0Jin Kyo Choi1Young Dae Kim2Hyo Suk Nam3Hyungjong Park4Hye Sun Lee5Ji Hoe Heo6 Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Korea Department of Neurology, Yonsei University College of Medicine, Seoul, Korea Department of Neurology, Yonsei University College of Medicine, Seoul, Korea Department of Neurology, Yonsei University College of Medicine, Seoul, Korea Department of Neurology, Yonsei University College of Medicine, Seoul, Korea Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea Department of Neurology, Yonsei University College of Medicine, Seoul, KoreaBackground and Purpose Nonbacterial thrombotic endocarditis (NBTE) is a cause of stroke in cancer. However, clinical characteristics and outcomes in stroke patients with cancer-associated NBTE are not well known. Methods We included consecutive patients with stroke and active cancer over a 9-year period who underwent echocardiography. We retrospectively compared clinical characteristics and presence of metastasis between patients with NBTE, those with cryptogenic etiologies, and those with determined etiologies. We also investigated mortality and stroke events during the 6-month follow-up. Results Among the 245 patients, 20 had NBTE, 96 had cryptogenic etiologies, and 129 had determined etiologies. Metastasis was seen in all 20 patients (100%) with NBTE, 69.8% in patients with cryptogenic etiology, and 48.8% in patients with or determined etiology. During the 6-month follow-up, 127 patients (51.8%) developed stroke and/or died (death in 110 [44.9%] and stroke events in 55 [22.4%]). Patients with NBTE showed significantly higher mortality (80%) and stroke occurrence (50%) than those with cryptogenic etiologies (mortality 54.2%, stroke 25.0%, log-rank P=0.006) and determined etiologies (mortality 32.6%, stroke 16.3%, log-rank P<0.001). In a multivariate Cox proportional hazard analysis, the presence of NBTE was independently associated with composite outcomes of mortality and stroke events (hazard ratio, 1.941; 95% confidence interval, 1.052 to 3.690). Conclusions NBTE should be suspected as a potential cause of stroke in patients with metastatic cancer. Patients with NBTE have a high risk of recurrent stroke and mortality. Future studies are necessary to determine strategies to reduce stroke recurrence in patients with NBTE.http://www.j-stroke.org/upload/pdf/jos-2020-00619.pdfstrokeneoplasmsmetastasismortalitynonbacterial thrombotic endocarditis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Joonsang Yoo Jin Kyo Choi Young Dae Kim Hyo Suk Nam Hyungjong Park Hye Sun Lee Ji Hoe Heo |
spellingShingle |
Joonsang Yoo Jin Kyo Choi Young Dae Kim Hyo Suk Nam Hyungjong Park Hye Sun Lee Ji Hoe Heo Outcome of Stroke Patients with Cancer and Nonbacterial Thrombotic Endocarditis Journal of Stroke stroke neoplasms metastasis mortality nonbacterial thrombotic endocarditis |
author_facet |
Joonsang Yoo Jin Kyo Choi Young Dae Kim Hyo Suk Nam Hyungjong Park Hye Sun Lee Ji Hoe Heo |
author_sort |
Joonsang Yoo |
title |
Outcome of Stroke Patients with Cancer and Nonbacterial Thrombotic Endocarditis |
title_short |
Outcome of Stroke Patients with Cancer and Nonbacterial Thrombotic Endocarditis |
title_full |
Outcome of Stroke Patients with Cancer and Nonbacterial Thrombotic Endocarditis |
title_fullStr |
Outcome of Stroke Patients with Cancer and Nonbacterial Thrombotic Endocarditis |
title_full_unstemmed |
Outcome of Stroke Patients with Cancer and Nonbacterial Thrombotic Endocarditis |
title_sort |
outcome of stroke patients with cancer and nonbacterial thrombotic endocarditis |
publisher |
Korean Stroke Society |
series |
Journal of Stroke |
issn |
2287-6391 2287-6405 |
publishDate |
2020-05-01 |
description |
Background and Purpose Nonbacterial thrombotic endocarditis (NBTE) is a cause of stroke in cancer. However, clinical characteristics and outcomes in stroke patients with cancer-associated NBTE are not well known. Methods We included consecutive patients with stroke and active cancer over a 9-year period who underwent echocardiography. We retrospectively compared clinical characteristics and presence of metastasis between patients with NBTE, those with cryptogenic etiologies, and those with determined etiologies. We also investigated mortality and stroke events during the 6-month follow-up. Results Among the 245 patients, 20 had NBTE, 96 had cryptogenic etiologies, and 129 had determined etiologies. Metastasis was seen in all 20 patients (100%) with NBTE, 69.8% in patients with cryptogenic etiology, and 48.8% in patients with or determined etiology. During the 6-month follow-up, 127 patients (51.8%) developed stroke and/or died (death in 110 [44.9%] and stroke events in 55 [22.4%]). Patients with NBTE showed significantly higher mortality (80%) and stroke occurrence (50%) than those with cryptogenic etiologies (mortality 54.2%, stroke 25.0%, log-rank P=0.006) and determined etiologies (mortality 32.6%, stroke 16.3%, log-rank P<0.001). In a multivariate Cox proportional hazard analysis, the presence of NBTE was independently associated with composite outcomes of mortality and stroke events (hazard ratio, 1.941; 95% confidence interval, 1.052 to 3.690). Conclusions NBTE should be suspected as a potential cause of stroke in patients with metastatic cancer. Patients with NBTE have a high risk of recurrent stroke and mortality. Future studies are necessary to determine strategies to reduce stroke recurrence in patients with NBTE. |
topic |
stroke neoplasms metastasis mortality nonbacterial thrombotic endocarditis |
url |
http://www.j-stroke.org/upload/pdf/jos-2020-00619.pdf |
work_keys_str_mv |
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