Who Should Rather Undergo Transesophageal Echocardiography to Determine Stroke Etiology: Young or Elderly Stroke Patients?
Who Should Rather Undergo Transesophageal Echocardiography to Determine Stroke Etiology: Young or Elderly Stroke Patients?
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DOI：
10.3389/fneur.2020.588151
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发表时间：
2020
影响因子：
3.4
通讯作者：
Harloff A
中科院分区：
文献类型：
--
作者：
Strecker C;Günther F;Harloff A
导言：经食道超声心动图(TEE)在急性卒中中的应用尚不清楚。因此，我们系统地研究了TEE对不同年龄段的隐源性卒中患者确定卒中病因和二级预防的影响。方法：前瞻性研究485例急性视网膜或脑缺血患者，均接受常规TEE卒中检查。根据TOAST分类确定卒中病因，并将患者分为已确定的卒中病因和未见TEE结果的不明原因卒中患者。然后，在55岁、55-74岁和≥75岁的有隐源性卒中病因的患者中，评估TEE中高危和潜在危险源的频率。结果：在没有TEE的情况下，329例(67.8%)患者卒中病因不明，其中158例(48.4%)TEE确定了可能的病因。在55岁、55岁~74岁、≥75岁的患者中，TEE检出4 mm厚≥斑块2例(1.2%)、37例(23.0%)、33例(40.2%)，斑块合并血栓0例(0.0%)、5例(3.1%)、7例(8.5%)；左心耳最大排空速度≤30 cm/S分别为0(0.0%)、1(0.6%)、2(2.4%)，自发回声对比0(0.0%)、1(0.6%)、6(7.3%)，心内膜炎0(0.0%)、0(0.0%)、1(1.2%)，卵圆孔未闭合并房间隔动脉瘤18例(20.9%)、32例(19.9%)、14例(17.1%)。分别进行了分析。TEE改变了这些患者中16.4%的二级预防措施，遵循2010/11年的指南，而在应用2020年的指南时仍有9.4%。结论：根据现有的治疗指南和专家意见，TEE在大多数病例中对确定卒中病因具有很高的价值，并影响个体二级预防。在年轻患者中，TEE的影响仅限于发现间隔异常。相比之下，在老年患者中，TEE检测到大量复杂的主动脉动脉粥样硬化和阵发性心房颤动的潜在指标。
Introduction: The indication of transesophageal echocardiography (TEE) in acute stroke is unclear. Thus, we systematically studied the impact of TEE on determining stroke etiology and secondary prevention in patients of different age-groups with cryptogenic stroke. Methods: Four hundred and eighty five consecutive patients with acute retinal or cerebral ischemia were prospectively included and underwent routine stroke workup including TEE. Stroke etiology was identified according to the TOAST classification and patients were divided in those with determined and cryptogenic stroke etiology without TEE results. Then, the frequency of high- and potential-risk sources in TEE was evaluated in <55, 55–74, and ≥75 year-old patients with cryptogenic stroke etiology. Results: Without TEE, stroke etiology was cryptogenic in 329(67.8%) patients and TEE determined possible etiology in 158(48.4%) of them. In patients aged <55, 55–74, ≥75, TEE detected aortic arch plaques ≥4 mm thickness in 2(1.2%), 37(23.0%), and 33(40.2%) and plaques with superimposed thrombi in 0(0.0%), 5(3.1%), and 7(8.5%); left atrial appendage peak emptying flow velocity ≤30cm/s in 0(0.0%), 1(0.6%), and 2(2.4%), spontaneous echo contrast in 0(0.0%), 1(0.6%), and 6(7.3%), endocarditis in 0(0.0%), 0(0.0%), and 1(1.2%) and patent foramen ovale (PFO) plus atrial septum aneurysm (ASA) in 18(20.9%), 32(19.9%), and 14(17.1%), respectively. TEE changed secondary prevention in 16.4% of these patients following guidelines of 2010/11 and still 9.4% when applying the guidelines of 2020. Conclusions: TEE was highly valuable for determining stroke etiology and influenced individual secondary prevention based on available treatment guidelines and expert opinion in most cases. In young patients the impact of TEE was limited to the detection of septal anomalies. By contrast, in older patients TEE detected high numbers of complex aortic atheroma and potential indicators of paroxysmal atrial fibrillation.
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影响因子：
6.2
作者：
Lang, Roberto M.;Badano, Luigi P.;Voigt, Jens-Uwe
通讯作者：
Voigt, Jens-Uwe
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