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

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 CHA(2)DS(2)-VASc-score and heart failure. AF, larger atrial septallateral 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. (C) 2018 Association for Research into Arterial Structure and Physiology. Published by Elsevier B.V. All rights reserved.