Katsanos A H, Giannopoulos S, Frogoudaki A, Vrettou A-R, Ikonomidis I, Paraskevaidis I, Zompola C, Vadikolias K, Boviatsis E, Parissis J, Voumvourakis K, Kyritsis A P, Tsivgoulis G
Department of Neurology, School of Medicine, University of Ioannina, Ioannina, Greece.
Second Department of Neurology, 'Attikon University Hospital', School of Medicine, University of Athens, Athens, Greece.
Eur J Neurol. 2016 Mar;23(3):569-79. doi: 10.1111/ene.12897. Epub 2015 Nov 19.
The diagnostic utility of transesophageal echocardiography (TEE) in patients with cryptogenic ischaemic stroke (IS) or transient ischaemic attack (TIA) remains controversial.
A systematic review and meta-analysis was performed according to PRISMA guidelines to estimate the pooled prevalence of potential cardioembolic causes detected by TEE in prospective observational studies of cryptogenic IS/TIA. Cardiac conditions causally associated with cerebral ischaemia were considered to be intramural thrombi and intracardiac tumors according to ASCO phenotyping of IS.
Thirty-five eligible studies, comprising 5772 patients (mean age 53.6 years, 56.9% men) were identified. The most common TEE finding was ascending aorta and/or aortic arch atheroma [51.2% (27.4%-74.5%)], followed by patent foramen ovale (PFO) [43.2% (36.3%-50.4%)]. Complex aortic plaques and large PFOs were reported in 14% (10.2%-18.9%) and 19.5% (16.6%-22.8%) of TEE evaluations. The prevalence of atrial septal aneurysm was 12.3% (7.9%-18.7%) and was significantly higher in conjunction with PFO presence (risk ratio 2.04, 95% confidence interval 1.63-2.54, P < 0.001). The prevalence of left atrial thrombus [3.0% (1.1%-8.3%)] and spontaneous echo contrast [3.8% (2.3%-6.2%)] was low. The prevalence of intracardiac tumors was extremely uncommon [0.2% (0%-0.7%)]. Significant heterogeneity was identified (I(2) > 60%) in the majority of analyses. Heterogeneity was not affected by cryptogenic stroke definition (TOAST versus alternative criteria). After dichotomizing available studies using a cut-off of 50 years, PFO was significantly (P = 0.001) more prevalent in younger than in older patients.
Routine TEE in patients with cryptogenic IS/TIA commonly identifies abnormal findings. However, the prevalence of cardiac conditions considered to be causally associated with cerebral ischaemia (intracardiac thrombi and tumors) is low.
经食管超声心动图（TEE）在隐源性缺血性卒中（IS）或短暂性脑缺血发作（TIA）患者中的诊断效用仍存在争议。
根据PRISMA指南进行系统评价和荟萃分析，以估计在隐源性IS/TIA前瞻性观察性研究中TEE检测到的潜在心源性栓塞病因的合并患病率。根据IS的美国国立心肺血液研究所（NHLBI）表型分析，与脑缺血有因果关系的心脏疾病被认为是壁内血栓和心内肿瘤。
共纳入35项符合条件的研究，包括5772例患者（平均年龄53.6岁，男性占56.9%）。TEE最常见的发现是升主动脉和/或主动脉弓粥样硬化[51.2%（27.4%-74.5%）]，其次是卵圆孔未闭（PFO）[43.2%（36.3%-50.4%）]。在14%（10.2%-18.9%）的TEE评估中报告了复杂主动脉斑块，在19.5%（16.6%-22.8%）的TEE评估中报告了大的PFO。房间隔瘤的患病率为12.3%（7.9%-18.7%），在伴有PFO时显著更高（风险比2.04，95%置信区间1.63-2.54，P<0.001）。左心房血栓[3.0%（1.1%-8.3%）]和自发显影[3.8%（2.3%-6.2%）]的患病率较低。心内肿瘤的患病率极为罕见[0.2%（0%-0.7%）]。在大多数分析中发现显著异质性（I²>60%）。异质性不受隐源性卒中定义（TOAST与其他标准）的影响。在以50岁为界对现有研究进行二分法分析后，PFO在年轻患者中的患病率显著高于老年患者（P=0.001）。
隐源性IS/TIA患者常规TEE检查常可发现异常结果。然而，被认为与脑缺血有因果关系的心脏疾病（心内血栓和肿瘤）的患病率较低。
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