经食管超声心动图对不明来源栓塞性卒中的价值。
The value of transesophageal echocardiography for embolic strokes of undetermined source.
作者信息
Katsanos Aristeidis H, Bhole Rohini, Frogoudaki Alexandra, Giannopoulos Sotirios, Goyal Nitin, Vrettou Agathi-Rosa, Ikonomidis Ignatios, Paraskevaidis Ioannis, Pappas Konstantinos, Parissis John, Kyritsis Athanassios P, Alexandrov Anne W, Triantafyllou Nikos, Malkoff Marc D, Voumvourakis Konstantinos, Alexandrov Andrei V, Tsivgoulis Georgios
机构信息
From the Department of Neurology (A.H.K., S.G., A.P.K.) and Second Department of Cardiology (K.P.), University Hospital of Ioannina, School of Medicine, University of Ioannina; Second Department of Neurology (A.H.K., K.V., G.T.) and Second Department of Cardiology (A.F., A.-R.V., I.I., I.P., J.P.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology (R.B., N.G., A.W.A., M.D.M., A.V.A., G.T.), University of Tennessee Health Science Center, Memphis; Australian Catholic University (A.W.A.), Sydney, Australia; First Department of Neurology (N.T.), Eginition University Hospital, School of Medicine, University of Athens, Greece; and International Clinical Research Center (G.T.), St. Anne's University Hospital in Brno, Czech Republic.
出版信息
Neurology. 2016 Sep 6;87(10):988-95. doi: 10.1212/WNL.0000000000003063. Epub 2016 Aug 3.
OBJECTIVE
Our aim was to evaluate the diagnostic yield of transesophageal echocardiography (TEE) in consecutive patients with ischemic stroke (IS) fulfilling the diagnostic criteria of embolic strokes of undetermined source (ESUS).
METHODS
We prospectively evaluated consecutive patients with acute IS satisfying ESUS criteria who underwent in-hospital TEE examination in 3 tertiary care stroke centers during a 12-month period. We also performed a systematic review and meta-analysis estimating the cumulative effect of TEE findings on therapeutic management for secondary stroke prevention among different IS subgroups.
RESULTS
We identified 61 patients with ESUS who underwent investigation with TEE (mean age 44 ± 12 years, 49% men, median NIH Stroke Scale score = 5 points [interquartile range: 3-8]). TEE revealed additional findings in 52% (95% confidence interval [CI]: 40%-65%) of the study population. TEE findings changed management (initiation of anticoagulation therapy, administration of IV antibiotic therapy, and patent foramen ovale closure) in 10 (16% [95% CI: 9%-28%]) patients. The pooled rate of reported anticoagulation therapy attributed to abnormal TEE findings among 3,562 acute IS patients included in the meta-analysis (12 studies) was 8.7% (95% CI: 7.3%-10.4%). In subgroup analysis, the rates of initiation of anticoagulation therapy on the basis of TEE investigation did not differ (p = 0.315) among patients with cryptogenic stroke (6.9% [95% CI: 4.9%-9.6%]), ESUS (8.1% [95% CI: 3.4%-18.1%]), and IS (9.4% [95% CI: 7.5%-11.8%]).
CONCLUSIONS
Abnormal TEE findings may decisively affect the selection of appropriate therapeutic strategy in approximately 1 of 7 patients with ESUS.
目的
我们的目的是评估经食管超声心动图（TEE）对符合不明来源栓塞性卒中（ESUS）诊断标准的连续性缺血性卒中（IS）患者的诊断价值。
方法
我们前瞻性评估了在12个月期间于3个三级医疗卒中中心接受住院TEE检查的符合ESUS标准的急性IS连续性患者。我们还进行了一项系统评价和荟萃分析，以估计TEE检查结果对不同IS亚组二级卒中预防治疗管理的累积影响。
结果
我们确定了61例接受TEE检查的ESUS患者（平均年龄44±12岁，49%为男性，美国国立卫生研究院卒中量表评分中位数=5分[四分位间距：3 - 8]）。TEE在52%（95%置信区间[CI]：40% - 65%）的研究人群中发现了额外的检查结果。TEE检查结果改变了10例（16%[95%CI：9% - 28%]）患者的治疗管理（启动抗凝治疗、给予静脉抗生素治疗以及卵圆孔未闭封堵）。在荟萃分析（12项研究）纳入的3562例急性IS患者中，因TEE检查结果异常而进行抗凝治疗的汇总发生率为8.7%（95%CI：7.3% - 10.4%）。在亚组分析中，隐源性卒中患者（6.9%[95%CI：4.9% - 9.6%]）、ESUS患者（8.1%[95%CI：3.4% - 18.1%]）和IS患者（9.4%[95%CI：7.5% - 11.8%]）中，基于TEE检查而启动抗凝治疗的发生率无差异（p = 0.315）。
结论
异常的TEE检查结果可能会对约七分之一的ESUS患者选择合适的治疗策略产生决定性影响。
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