It is well known that silent
myocardial ischemia (SMI) often complicates patients with
cerebral infarction and that
stroke patients often die of
ischemic heart disease. Therefore, it is considered important to treat
myocardial ischemia in
stroke patients. This study investigated SMI complicating Japanese patients with fresh
stroke, using (99m)Tc-tetrofosmin myocardial scintigraphy with pharmacologic stress testing to elucidate their clinical manifestations. This study included 41 patients (26 men, mean age 76.0 ± 10.7 years) with acute
cerebral infarction and no history of
coronary artery disease. All patients underwent (99m)Tc-tetrofosmin myocardial scintigraphy with
intravenous administration of
adenosine to diagnose SMI. Of the 41 patients,
myocardial ischemia was confirmed in 17 patients (41.5%). Atherosclerotic etiology was the major cause of
stroke in the
ischemia(+) group and embolic origin was the major cause in the
ischemia(-) group. Patients with
myocardial ischemia had a higher incidence of
diabetes mellitus (52.9 vs 20.8%; P = 0.0323) and more than two conventional cardiovascular risk factors (64.7 vs 25.0%; P = 0.0110) compared with the nonischemic patients.
Infarction subtype of atherosclerotic origin was an independent positive predictor of asymptomatic
myocardial ischemia in patients with
stroke. These findings indicate that the prevalence of asymptomatic
myocardial ischemia is relatively high, especially in patients with
stroke of atherosclerotic origin. Therefore, it is beneficial for us to narrow the target population who are at the highest risk when screening for SMI in Japanese patients with acute
cerebral infarction.