Value of routine echocardiography in the management of stroke
Value of routine echocardiography in the management of stroke
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DOI：
10.1503/cmaj.190111
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发表时间：
2019-08-06
影响因子：
14.6
通讯作者：
Verma, Amol A.
中科院分区：
文献类型：
--
作者：
Fralick, Mike;Goldberg, Nicola;Verma, Amol A.
背景：经胸超声心动图是卒中或短暂性脑缺血发作（TIA）患者的常规检查，以帮助计划继发性卒中治疗，但最近缺乏评估其在这方面有效性的数据。我们试图评估超声心动图在确定继发性中风预防的临床可操作发现方面的价值。方法：我们在加拿大安大略省多伦多市的2所学术医院对2010年至2015年间因中风或TIA入院的患者进行了一项多中心队列研究。临床可操作的超声心动图结果包括心脏血栓、卵圆孔未闭、心房黏液瘤或瓣膜赘生物。我们使用逻辑回归确定了与临床可操作发现相关的患者特征。结果：在我们确定的1862例卒中或TIA患者中，1272例（68%）至少有1次超声心动图。几乎所有超声心动图都是经胸的；1097例（86%）正常，1例（0.08%）有心房黏液瘤，2例（0.2%）有瓣膜赘生物，11例（0.9%）有心脏血栓，66例（5.2%）有PFO。60岁以上患者（校正优势比[OR] 0.34, 95%可信区间[CI] 0.20-0.57）、既往卒中或TIA（校正优势比[OR] 0.31, 95% CI 0.09-0.76）或血脂异常（校正优势比[OR] 0.39, 95% CI 0.15-0.84）发生卵圆孔未闭的可能性较小。130例隐源性脑卒中超声心动图（110例）中，19例（17%）经胸超声心动图检测到PFO。解释：大多数卒中或TIA患者超声心动图正常，很少有临床可操作的继发性卒中预防结果。临床可操作的发现，特别是PFO，在隐源性卒中患者中更常见。
BACKGROUND: Transthoracic echocardiography is routinely performed in patients with stroke or transient ischemic attack (TIA) to help plan secondary stroke management, but recent data evaluating its usefulness in this context are lacking. We sought to evaluate the value of echocardiography for identifying clinically actionable findings for secondary stroke prevention. METHODS: We conducted a multicentre cohort study of patients admitted to hospital with stroke or TIA between 2010 and 2015 at 2 academic hospitals in Toronto, Ontario, Canada. Clinically actionable echocardiographic findings for secondary stroke prevention included cardiac thrombus, patent foramen ovale, atrial myxoma or valvular vegetation. We identified patient characteristics associated with clinically actionable findings using logistic regression. RESULTS: Of the 1862 patients with stroke or TIA we identified, 1272 (68%) had at least 1 echocardiogram. Nearly all echocardiograms were transthoracic; 1097 (86%) were normal, 1 (0.08%) had an atrial myxoma, 2 (0.2%) had a valvular vegetation, 11 (0.9%) had a cardiac thrombus and 66 (5.2%) had a PFO. Patent foramen ovale was less likely among patients older than 60 years (adjusted odds ratio [OR] 0.34, 95% confidence interval [CI] 0.20-0.57), with prior stroke or TIA (adjusted OR 0.31, 95% CI 0.09-0.76) or with dyslipidemia (adjusted OR 0.39, 95% CI 0.15-0.84). Among the 130 patients with cryptogenic stroke who had an echocardiogram (n = 110), a PFO was detected in 19 (17%) on transthoracic echocardiogram. INTERPRETATION: Most patients with stroke or TIA had a normal echocardiogram, with few having clinically actionable findings for secondary stroke prevention. Clinically actionable findings, specifically PFO, were more common in patients with cryptogenic stroke.