Departments of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada Departments of Radiology, University of Calgary, Calgary, Alberta, Canada Community Health Sciences, University of Calgary, Calgary, Alberta, Canada Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
Departments of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
Postgrad Med J. 2014 Aug;90(1066):434-8. doi: 10.1136/postgradmedj-2013-132220. Epub 2014 Jun 11.
To determine the diagnostic yield of echocardiography and its utility in changing medical management; and to derive a risk score to guide its use in patients with in-hospital stroke or transient ischaemic attack (TIA).
We carried out a retrospective chart review from January 2009 to June 2010 of patients with acute ischaemic stroke or TIA who had undergone transthoracic echocardiography (TTE) or transoesophageal echocardiography (TOE). Clinical and imaging findings at baseline were noted and 'potential clinically relevant findings' identified on TTE and TOE. A multivariable logistic regression was used to identify predictors of potential clinically relevant findings on TTE or TOE and derive a risk score.
Of 370 patients, 307 (83.0%) had TTE and 63 (17.0%) had additional TOE. Potential clinically relevant findings on echocardiography were noted in 28 (7.6%) patients. Change in medical management was noted in 19/307 (6.2%) patients on TTE and in 7/63 (11.1%) patients on TOE. Male sex (OR 3.05, 95% CI 1.19 to 7.84; p=0.021), abnormal admission ECG (OR 4.39, 95% CI 1.79 to 10.79; p=0.001), and embolic pattern imaging at baseline (OR 2.38, 95% CI 1.05 to 5.40; p=0.038) were independent predictors of findings on TTE or TOE. A risk score including these three variables had modest discrimination (c-statistic 0.69, 95% CI 0.59 to 0.80).
Echocardiography detected potential clinically relevant findings in a minority of patients (7.6%), but these findings changed medical management 90.5% of the time. A risk score using sex, ECG abnormality, and embolic pattern imaging at baseline could help predict which patients are more likely to have these echo findings.
确定超声心动图的诊断收益及其在改变医学管理中的效用；并制定风险评分以指导住院中风或短暂性脑缺血发作（TIA）患者使用。
我们对 2009 年 1 月至 2010 年 6 月期间接受经胸超声心动图（TTE）或经食管超声心动图（TOE）检查的急性缺血性中风或 TIA 患者进行了回顾性病历审查。记录基线时的临床和影像学发现，并确定 TTE 和 TOE 上的“潜在临床相关发现”。采用多变量逻辑回归来确定 TTE 或 TOE 上潜在临床相关发现的预测因素，并得出风险评分。
在 370 名患者中，307 名（83.0%）接受了 TTE，63 名（17.0%）接受了额外的 TOE。在 28 名（7.6%）患者中发现了超声心动图上的潜在临床相关发现。在 TTE 上，19/307 名（6.2%）患者的医学管理发生了变化，在 TOE 上，7/63 名（11.1%）患者的医学管理发生了变化。男性（OR 3.05，95%CI 1.19 至 7.84；p=0.021）、异常入院心电图（OR 4.39，95%CI 1.79 至 10.79；p=0.001）和基线时栓塞模式影像学（OR 2.38，95%CI 1.05 至 5.40；p=0.038）是 TTE 或 TOE 发现的独立预测因素。包括这三个变量的风险评分具有适度的鉴别力（c 统计量 0.69，95%CI 0.59 至 0.80）。
超声心动图在少数患者（7.6%）中发现了潜在的临床相关发现，但这些发现改变了 90.5%的医学管理。使用性别、心电图异常和栓塞模式影像学的基线风险评分可以帮助预测哪些患者更有可能出现这些超声心动图发现。
