Transoesophageal echocardiography in patients with acute stroke with sinus rhythm and no cardiac disease history
Transoesophageal echocardiography in patients with acute stroke with sinus rhythm and no cardiac disease history
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DOI：
10.1136/jnnp.2009.190322
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发表时间：
2010-04-01
影响因子：
11
通讯作者：
Heo, Ji Hoe
中科院分区：
文献类型：
--
作者：
Cho, Hyun-Ji;Choi, Hye-Yeon;Heo, Ji Hoe
背景经食管超声心动图（TOE）是检测潜在心源性栓塞（PCSE）的金标准。然而，TOE在缺血性卒中患者正常窦性心律（NSR），没有心脏病的作用仍然uncertaints.Methods作者回顾性分析了1833例连续缺血性卒中NSR和没有心脏病史的TOE检查。作者调查了这些患者中检出的PCSE和主动脉斑块的频率。根据ORG 10172试验的急性卒中治疗分类确定高风险和中风险PCSE。作者还确定了TOE.Results后，1833例患者中有753例（41.1%）检测到PCSE和/或主动脉斑块。TOE后，323例患者（17.6%）共发现355例PCSE（45例高风险PCSE和310例中风险PCSE）。主动脉斑块502例（27.4%）。其中，复杂的主动脉斑块，这是栓塞的重要来源，发现在157例（8.5%）。根据现行指南的二级预防治疗策略的变化将有必要在63例患者（3.4%）后TOE examination.Conclusion潜在的栓塞源从心脏和主动脉可以检测到TOE检查在许多患者与NSR和无心脏疾病的中风，这使得更好地确定中风的机制。
Background Transoesophageal echocardiography (TOE) is the gold standard for detecting potential cardiac sources of embolism (PCSE). However, the role of TOE in patients with ischaemic stroke with normal sinus rhythm (NSR) and no cardiac disease remains uncertain.Methods The authors retrospectively analysed 1833 consecutive patients with ischaemic stroke with NSR and no history of cardiac disease who were examined by TOE. The authors investigated the frequency of PCSE and aortic plaques detected in these patients. Determination of high- and medium-risk PCSE was based on the Trial of ORG 10172 in the Acute Stroke Treatment classification. The authors also determined how the proportions of stroke subtypes and treatment strategies based on current guidelines have been changed after TOE.Results PCSE and/or aortic plaques were detected in 753 (41.1%) of 1833 patients. After TOE, a total of 355 PCSE (45 high- risk PCSE and 310 medium-risk PCSE) were found in 323 patients (17.6%). Aortic plaques were found in 502 patients (27.4%). Among these, complex aortic plaques, which are significant sources of embolism, were found in 157 patients (8.5%). Changes in treatment strategies for secondary prevention based on the current guidelines would have been necessary in 63 patients (3.4 %) after TOE examination.Conclusion Potential embolic sources from the heart and aorta can be detected by TOE examination in many patients with stroke with NSR and no cardiac disease, which enables a better determination of stroke mechanisms.