[经食管超声心动图在检测卒中及短暂性脑缺血发作中心源性和主动脉源性栓塞的作用]

[The role of transesophageal echocardiopgraphy in detection of cardiogenic and aortic sources of embolism in stroke and transient ischaemic attacks].

作者信息

Dúbrava J, Garay R

机构信息

Oddelenie funkcnej diagnostiky FNsP Bratislava, pracovisko Petrzalka, Slovenská republika.

出版信息

Vnitr Lek. 2006 Feb;52(2):144-51.

PMID:16623277

Abstract

OBJECTIVES

To prospectively investigate the prevalence of definite and potential sources of cardiogenic embolism and embolism from ascending aorta and aortic arch in patients with a cryptogenic stroke or transient ischaemic attack (TIA).

MATERIAL/METHODS: The study group consisted of 218 consecutive patients (146 males, mean age 59.4 +/- 11.5, range 38-83 years) without significant stenoses of carotic and vertebral arteries. All patients underwent biplane/multiplane transesophageal echocardiography (TEE). 77.5% of patients suffered a stroke and 22.5% had a TIA. Sinus rhythm was in 74.8% of the patients, atrial fibrillation in 22.0% and pacemaker rhythm in 3.2%.

RESULTS

Definite source of embolism was identified in 21.6% of patients. The most frequent finding was a thrombus of the left atrial (LA) appendage - 12.4%. Less frequently found were mobile thrombus of aortic arch - 3.7%, thrombus of LA body - 2.3%, left ventricular thrombus - 2.3%, thrombus of valvular prosthesis - 1.4% and heart tumor - 0.5%. 2. The total prevalence of potential sources of embolism was 61.5%. Only potential source (without definite source) was demonstrated in 52.3% of patients. Very frequently were found patent foramen ovale - 58.3% and atherosclerosis of ascending aorta or aortic arch - 53.7%. Further sources were LA spontaneous echocontrast - 21.1%, reduced function of LA appendage - 18.3%, atrial septal aneurysm - 7.8%, atrial septal defect - 1.4%, cardiac foreign body - 0.5%. 3. TEE did not reveal any source of embolism in 26.1% of patients.

CONCLUSIONS

21.6% of the patients suffering from stroke/TIA without hemodynamically significant stenoses of extracranial cerebral arteries had a definite cardiogenic or aortic source of embolism, 2. additional 52.3% of patients had only potential source of embolism (without definite source), 3. we consider TEE necessary in patients with stroke/TIA without a known etiology, despite complete neurological examination and transthoracic echocardography.

摘要

目的

前瞻性调查不明原因卒中或短暂性脑缺血发作（TIA）患者心源性栓塞以及升主动脉和主动脉弓栓塞的确切和潜在来源的患病率。

材料/方法：研究组由218例连续患者组成（146例男性，平均年龄59.4±11.5岁，范围38 - 83岁），其颈内动脉和椎动脉无明显狭窄。所有患者均接受了双平面/多平面经食管超声心动图（TEE）检查。77.5%的患者发生了卒中，22.5%的患者有TIA。74.8%的患者为窦性心律，22.0%为心房颤动，3.2%为起搏器心律。

结果

21.6%的患者确定有栓塞来源。最常见的发现是左心耳血栓——12.4%。较少见的有主动脉弓活动血栓——3.7%、左心房体部血栓——2.3%、左心室血栓——2.3%、人工瓣膜血栓——1.4%和心脏肿瘤——0.5%。2. 栓塞潜在来源的总患病率为61.5%。52.3%的患者仅显示有潜在来源（无确切来源）。非常常见的有卵圆孔未闭——58.3%和升主动脉或主动脉弓动脉粥样硬化——53.7%。其他来源有左心房自发显影——21.1%、左心耳功能减退——18.3%、房间隔瘤——7.8%、房间隔缺损——1.4%、心脏异物——0.5%。3. 26.1%的患者TEE未发现任何栓塞来源。