Gaspar António, Silva Isabel, Costeira Pereira António, Salomé Nuno, António Mariz José, Brandão Aida, Fernandes Francisco, Simões Alda, Salgado Alberto, Correia Adelino
Serviço de Cardiologia, Hospital de Braga, Braga, Portugal.
Rev Port Cardiol. 2011 Jul;30(7-8):643-8. doi: 10.1016/S0870-2551(11)70002-6.
Ischemic stroke is the leading cause of mortality in Portugal, with around 30 to 50 % of cases being of cardioembolic etiology. Transesophageal echocardiography (TEE) has assumed growing importance in the detection of cardiac sources of embolism. However, there is controversy regarding the implications of TEE findings for the therapeutic approach to patients with ischemic stroke.
To analyze TEE findings in the diagnostic work-up of patients with ischemic cerebral events and to determine their influence on therapeutic strategy.
We retrospectively studied patients with stroke or transient ischemic attack (TIA) before the age of 65, of no apparent cause after carotid ultrasound, electrocardiogram and transthoracic echocardiography, who underwent TEE between 1992 and 2009. The following diagnoses on TEE were considered as potential embolic sources: atrial septal defect; patent foramen ovale (PFO); atrial septal aneurysm (ASA); vegetations; tumors; intracavitary thrombi; and aortic plaques >2mm (ascending aorta and arch).
We analyzed 294 patients, mean age 45 years, 56.8 % men. TEE revealed a potential cardioembolic source in 36.7 % of the patients, PFO and ASA being the most frequent. Throughout the period considered, there was an increase in the number of exams performed, as well as in diagnoses, mainly PFO and ASA. Comparison of patients with and without a diagnosis on TEE showed that the former were older and were more often prescribed oral anticoagulation. By multivariate analysis, the presence of a positive TEE finding was shown to be an independent predictor of treatment with oral anticoagulation (OR=2.48; CI 95%: 1.42-4.34; p=0.001).
In the population under analysis, TEE was useful in identifying potential cardioembolic sources and influenced the therapeutic strategy.
缺血性中风是葡萄牙的主要死亡原因，约30%至50%的病例为心源性栓塞病因。经食管超声心动图（TEE）在检测心脏栓塞源方面的重要性日益凸显。然而，TEE检查结果对缺血性中风患者治疗方法的影响存在争议。
分析TEE在缺血性脑事件患者诊断检查中的结果，并确定其对治疗策略的影响。
我们回顾性研究了1992年至2009年间接受TEE检查的65岁以下中风或短暂性脑缺血发作（TIA）患者，这些患者在颈动脉超声、心电图和经胸超声心动图检查后无明显病因。TEE检查发现的以下诊断被视为潜在的栓塞源：房间隔缺损；卵圆孔未闭（PFO）；房间隔瘤（ASA）；赘生物；肿瘤；心腔内血栓；以及直径>2mm的主动脉斑块（升主动脉和主动脉弓）。
我们分析了294例患者，平均年龄45岁，男性占56.8%。TEE显示36.7%的患者存在潜在的心源性栓塞源，其中PFO和ASA最为常见。在整个研究期间，检查数量以及诊断数量均有所增加，主要是PFO和ASA。对有和没有TEE诊断的患者进行比较，结果显示前者年龄更大，更常接受口服抗凝治疗。多因素分析表明，TEE检查结果呈阳性是口服抗凝治疗的独立预测因素（OR=2.48；95%置信区间：1.42 - 4.34；p=0.001）。
在所分析的人群中，TEE有助于识别潜在的心源性栓塞源并影响治疗策略。
