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Abstract<br />INTRODUCTION: Rheumatic valvular disease is a common complication of rheumatic<br />fever in children in developing countries. Later in life, rheumatic valvular disease<br />becomes an important modifiable risk factor of stroke. The incidence of rheumatic<br />valvular disease and its complications are unknown in Iran.<br />METHODS: This is a prospective study of 302 consecutive patients admitted to a<br />tertiary care hospital in Iran, with a diagnosis of non-hemorrhagic stroke between June<br />2005 and June 2006. All patients underwent diagnostic workup to determine stroke<br />etiology according to clinical indications. Diagnosis and classification of stroke was made<br />based on the PIC criteria.<br />RESULTS: In 302 patients with stroke (mean age: 66.78&plusmn;14.36 years), 60 patients<br />(20%) (mean age: 65.61&plusmn;17.48 years) had cardiac sources of embolism (CSE). Rheumatic<br />mitral stenosis was present in 28 (46.6%) of these patients. Atrial fibrillation was<br />documented in 19 patients (67.8%) with rheumatic valvular disease. The remaining 32<br />patients (53.3%) had other CSE. In the latter group, 8 patients (25%) had non-valvular<br />atrial fibrillation. In the entire group with CSE, a total of 30 patients were candidates for<br />anticoagulation; among them, 14 (46.6%) were anticoagulated, but only 6 (20%) were<br />within therapeutic range at the time of their stroke.<br />CONCLUSIONS: Rheumatic valvular disease seems to be the most common CSE in Iran.<br />Many patients with rheumatic or non-rheumatic CSE are not adequately managed for<br />secondary prevention of cardioembolic stroke.<br />Key Words: Cardioembolic, stroke, rheumatic.