Aggarwal Vivek, Jayachandra A, Aggarwal Naveen, Ahmed Faiz
Assistant Professor (Medicine), Armed Forces Medical College, Pune 411040, India.
Assistant Professor (Cardiology), Army Hospital (R&R), Delhi Cantt, India.
Med J Armed Forces India. 2020 Jan;76(1):47-50. doi: 10.1016/j.mjafi.2018.07.006. Epub 2018 Oct 15.
The aim is to study cardiac abnormalities as detected by transesophageal echocardiography (TEE) in young patients (<40 years) presenting with acute ischemic arterial stroke.
A cross-sectional observational study was conducted in young patients aged <40 years presenting with acute arterial ischemic stroke without any valvular heart disease, prosthetic valve, or previously diagnosed atrial fibrillation (AF). TEE was performed in all eligible patients preferably within the first week of the onset of ischemic arterial stroke. All patients with normal TEE underwent holter to rule out paroxysmal AF.
Totally, 40 young patients were included in the study. Mean age was 35.17 (SD [standard deviation] ± 2.99) years. TEE abnormalities were noted in total 13 (32.5%) patients, of which patent foramen ovale was the most common cardiac abnormality in eight (20%) patients followed by left atrial appendage clot in three (7.5%) and atrial septal aneurysm in two (5%) patients. One patient (2.5%) was observed with atrial septal aneurysm along with a sieved septum. All the patients with normal TEE underwent holter, and four of 27 (14.8%) of these patients were noted to have paroxysmal AF.
Cardiac abnormalities on TEE and holter were detected in 42.5% of the young patients with idiopathic arterial stroke. TEE abnormality was noted in 33% (13/40), whereas AF on holter was seen in 14.8% (4/27) with normal TEE. Thus, probable cardioembolic stroke was responsible for acute ischemic stroke in 42.5% (17/40) of young patients in the absence of valvular heart disease, prosthetic valves, and persistent/permanent AF.
目的是研究经食管超声心动图（TEE）在急性缺血性动脉性卒中的年轻患者（<40岁）中检测到的心脏异常情况。
对年龄<40岁、患有急性动脉缺血性卒中且无任何瓣膜性心脏病、人工瓣膜或先前诊断的心房颤动（AF）的年轻患者进行了一项横断面观察性研究。所有符合条件的患者均在缺血性动脉性卒中发作的第一周内尽快进行TEE检查。所有TEE检查结果正常的患者均进行动态心电图监测以排除阵发性AF。
该研究共纳入40例年轻患者。平均年龄为35.17（标准差[SD]±2.99）岁。共有13例（32.5%）患者发现TEE异常，其中卵圆孔未闭是最常见的心脏异常，有8例（20%）患者出现，其次是左心耳血栓，有3例（7.5%）患者出现，房间隔瘤有2例（5%）患者出现。1例（2.5%）患者同时观察到房间隔瘤和筛状间隔。所有TEE检查结果正常的患者均进行了动态心电图监测，其中27例患者中有4例（14.8%）被发现有阵发性AF。
在42.5%的特发性动脉性卒中年轻患者中检测到TEE和动态心电图监测的心脏异常。TEE异常在33%（13/40）的患者中被发现，而TEE检查结果正常的患者中动态心电图监测发现AF的比例为14.8%（4/27）。因此，在无瓣膜性心脏病、人工瓣膜和持续性/永久性AF的情况下，42.5%（17/40）的年轻患者中急性缺血性卒中可能由心源性栓塞性卒中引起。
