Department of Cardiology, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia.
Intern Med J. 2010 Dec;40(12):813-8. doi: 10.1111/j.1445-5994.2009.02103.x.
Assessment for source of stroke is a common indication for transoesophageal echocardiography (TOE). Although an abnormality is frequently found, it remains uncertain how frequently the findings alter patient management. Also, the role of transthoracic echocardiography (TTE) prior to or instead of TOE is not well defined. We sought to determine the use of TTE prior to TOE, the outcome of the TOE and its impact on management.
We retrospectively reviewed the records and echocardiography results of 100 consecutive patients who underwent TOE for any reason at a tertiary hospital. In 35 subjects (35%), the indication was evaluation for source of stroke. Among these, we determined clinical risk factors for stroke, if a TTE was performed prior to their TOE, the results of the TOE and its effect on management.
The mean age of the stroke patients was 64.6 years (17-90) and 49% were women. Eighty per cent had at least one risk factor for stroke and 17% had atrial fibrillation. A TTE, performed in 40% prior to the TOE, found an abnormality in 14% (2/14). The TOE showed an abnormality in 71% of patients; 54% had aortic atheroma; 17% PFO; 14% spontaneous echo contrast; 6% left atrial appendage thrombus, 3% left ventricular thrombus and 3% vegetation. In only one patient (3%) the management was altered based on the abnormal TOE findings.
An abnormality on TOE, although common (71%) and more sensitive than TTE, altered management in only 3% of subjects referred for stroke assessment. Its role requires further consideration.
评估中风的病因是进行经食管超声心动图（TOE）的常见指征。尽管经常发现异常，但仍不确定这些发现会如何改变患者的治疗方案。此外，在进行 TOE 之前或代替 TOE 进行经胸超声心动图（TTE）的作用也尚未明确。我们旨在确定在进行 TOE 之前使用 TTE 的情况、TOE 的结果及其对治疗的影响。
我们回顾性地分析了在一家三级医院因任何原因接受 TOE 的 100 例连续患者的病历和超声心动图结果。在 35 例患者（35%）中，评估中风病因是其指征之一。在这些患者中，我们确定了中风的临床危险因素、如果在进行 TOE 之前进行了 TTE、TOE 的结果及其对治疗的影响。
中风患者的平均年龄为 64.6 岁（17-90 岁），其中 49%为女性。80%的患者至少有一个中风危险因素，17%的患者有房颤。在 40%的患者在进行 TOE 之前进行了 TTE，发现异常的占 14%（2/14）。TOE 显示 71%的患者存在异常；54%有主动脉粥样硬化；17%有卵圆孔未闭；14%有自发性回声对比；6%有左心耳血栓；3%有左心室血栓；3%有赘生物。只有 1 名患者（3%）根据异常的 TOE 结果改变了治疗方案。
尽管异常在 TOE 中很常见（71%），且比 TTE 更敏感，但在因中风评估而接受检查的患者中，仅有 3%的患者治疗方案发生改变。它的作用需要进一步考虑。
