VALUE OF CARDIAC MONITORING AND ECHOCARDIOGRAPHY IN TIA AND STROKE PATIENTS
VALUE OF CARDIAC MONITORING AND ECHOCARDIOGRAPHY IN TIA AND STROKE PATIENTS
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DOI：
10.1161/01.str.16.6.950
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发表时间：
1985-11-01
期刊：
影响因子：
8.3
通讯作者：
BARNETT, HJM
中科院分区：
文献类型：
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作者：
REM, JA;HACHINSKI, VC;BARNETT, HJM
184例因短暂性脑缺血发作（TIA）和脑梗死（卒中）入住研究性卒中单元的连续患者接受了48小时自动心律失常监测，55例患者接受了额外的霍尔特监测，127例患者接受了2-D超声心动图。116例患者出现卒中（63%），68例患者出现TIA（37%）。122例为男性（66.3%），62例为女性（33.7%），平均年龄63.5岁，范围25-86岁。监测发现12例（6.5%）患者存在病史、检查和入院心电图未发现的显著心律失常：6例为房颤（AF），4例为2.5度。心脏传导阻滞类型Mobitz II和3 °各1例。心脏传导阻滞和病态窦房结综合征。二维超声心动图显示了22例患者（17.3%）先前未知的潜在心脏栓塞来源：11例节段性心室疾病，7例二尖瓣脱垂，6例左心室血栓，3例左心室瘤，1例二尖瓣心内膜炎和整体心肌功能障碍。根据之前在我市对健康老年志愿者进行的M型超声心动图研究，预期仅二尖瓣结果。从临床病史和所有心脏检查中，我们发现59例（32%）患者可能有脑栓塞的心脏来源。在脑血管造影后，这59名患者中有29名还显示了相应颈动脉的血管病变，我们无法明确确定哪种病变是脑栓塞的原因。在其余30例患者（16.4%）中，证据表明心脏是最可能的来源。这些发现说明了心脏和动脉病变的共同巧合和困难的诊断心栓塞的信心。心律失常监测和2-D超声心动图检测到28例患者（15.2%）以前未被识别的可能的心脏源栓塞。通过这些研究对潜在可治疗疾病的具体识别表明，它们在TIA和卒中患者的治疗决策中是有价值的。
One hundred and eighty-four consecutive patients admitted to an Investigative Stroke Unit with transient ischemic attacks (TIA) and cerebral infarction (stroke) had 48-hour automated arrhythmia monitoring, 55 patients had additional Holter monitoring and 127 patients had 2-D echocardiography. One hundred and sixteen presented with stroke (63%) and 68 patients with TIA (37%). One hundred and twenty-two were men (66.3%) and 62 were women (33.7%), mean age 63.5 years, range 25-86. The monitoring identified twelve (6.5%) patients with significant arrhythmias undetected by history, examination and admission electrocardiogram: six with atrial fibrillation (AF), four with 2.degree. heart block type Mobitz II and one each with 3.degree. heart block and sick sinus syndrome. Two-D echocardiography showed a previously unknown potential source for cardiac emboli in 22 patients (17.3%): segmental ventricular disease in eleven, mitral valve prolapse in seven, left ventricular thrombus in six, left ventricular aneurysm in three and one each with mitral valve endocarditis and global myocardial dysfunction. Only the mitral valve findings were expected on the basis of a previous M-mode echocardiographic study carried out in our city on healthy elderly volunteers. From the clinical history and all cardiac investigations, we found 59 patients (32%) with a possible cardiac source for cerebral emboli. After cerebral angiography, 29 of these 59 patients also showed a vascular lesion in the appropriate carotid artery and we could not decide definitely which lesion was responsible for the cerebral embolus. In the remaining 30 patients (16.4%), the evidence implicated the heart as the most likely source. These findings illustrate the common coincidence of cardiac and arterial lesions and the difficulties of diagnosing cardiac embolism confidently. Arrhythmia monitoring and 2-D echocardiography detected a previously unrecognized possible cardiac source for emboli in 28 patients (15.2%). The specific identification of potentially treatable conditions by these investigations suggests that they are valuable in arriving at therapeutic decisions for TIA and stroke patients.