Strandberg Marjatta, Marttila Reijo J, Helenius Hans, Hartiala Jaakko
Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland.
Clin Physiol Funct Imaging. 2008 May;28(3):156-60. doi: 10.1111/j.1475-097X.2007.00785.x. Epub 2008 Jan 14.
In this present study, we tried to find out if there is a subgroup of patients that should not undergo transoesophageal echocardiography (TEE) after an ischaemic stroke or transient ischaemic attack (TIA).
A total of 441 consecutive unselected patients with ischaemic stroke or TIA suitable for anticoagulation were examined with TEE in the acute phase. The patients were divided into five subcategories according to their rhythm, age and the findings in carotid sonography, and into two groups according to the presence of clinical risk factors for ischaemic stroke or TIA.
From the 441 studied patients, 60 (14%) had chronic or paroxysmal atrial fibrillation (AF) and 381 (86%) were in sinus rhythm (SR). Of the patients in SR, 46 (12%) were below 50 years old. The carotid sonography was conducted in 240 patients above 50 years old and in SR, and <50% internal carotid artery (ICA) stenosis was found in 194 (81%) patients and > or =50% ICA in 46 (19%) patients. Potential cardiac sources of embolism were found in patients both with AF or in SR (70% versus 46%), both below and above 50-year-old patients in SR (37% versus 47%), both in over 50-year-old patients in SR with <50% ICA stenosis and > or =50% ICA stenosis (41% versus 61%) and in patients in SR either without or with clinical risk factors for ischaemic stroke or TIA (43% versus 51%). On the basis of the TEE study, oral anticoagulation was started in 36 (9%) patients in SR.
These results support TEE in patients with ischaemic stroke or TIA who are candidates for receiving oral anticoagulation.
在本研究中，我们试图找出缺血性中风或短暂性脑缺血发作（TIA）后不适合接受经食管超声心动图（TEE）检查的患者亚组。
对441例连续入选的适合抗凝治疗的缺血性中风或TIA患者在急性期进行了TEE检查。根据患者的心律、年龄及颈动脉超声检查结果将其分为五个亚类，根据是否存在缺血性中风或TIA的临床危险因素分为两组。
在441例研究患者中，60例（14%）有慢性或阵发性心房颤动（AF），381例（86%）为窦性心律（SR）。在窦性心律患者中，46例（12%）年龄低于50岁。对240例年龄大于50岁且为窦性心律的患者进行了颈动脉超声检查，194例（81%）患者颈内动脉（ICA）狭窄<50%，46例（19%）患者ICA狭窄≥50%。在AF患者和SR患者中均发现了潜在的心脏栓塞源（70%对46%），在SR的<50岁和≥50岁患者中均有发现（37%对47%），在SR的≥50岁且ICA狭窄<50%和≥50%的患者中均有发现（41%对61%），在SR的无或有缺血性中风或TIA临床危险因素的患者中也有发现（43%对51%）。基于TEE研究，36例（9%）窦性心律患者开始口服抗凝治疗。
这些结果支持对适合接受口服抗凝治疗的缺血性中风或TIA患者进行TEE检查。
