Harris Jennifer, Yoon Jason, Salem Mohamed, Selim Magdy, Kumar Sandeep, Lioutas Vasileios Arsenios
Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States.
Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, United States.
Front Neurol. 2020 Feb 18;11:103. doi: 10.3389/fneur.2020.00103. eCollection 2020.
Transthoracic echocardiography (TTE) is routinely performed as part of standard acute ischemic stroke (AIS) workup. However, the overall yield of TTE is unclear and many patients may undergo unnecessary investigations. This study aims to investigate the utility of TTE as part of AIS workup. We collected data on consecutive patients with AIS who were admitted to our institution between 07/01/2016 and 09/30/2017. Patients were included based on neuroimaging-documented AIS, age >18 and neuroimaging studies. Primary endpoint was the proportion of cases in which TTE yielded relevant finding, defined as Atrial Septa Defect or Patent Foramen Ovale, left atrial enlargement, left ventricular thrombus or ejection fraction of <35%. Secondary endpoint was the proportion of patients who had a TTE-drive change in management. Among 548 AIS patients (median age 71 [59-81] years, 50% female), 482 (87%) underwent TTE. Clinically relevant findings were observed in 183 (38%) patients, leading to additional workup in 41 (8.5%). Further workup was associated with younger median age (58 [50-65] vs. 72 [62-81], < 0.0001, and was less likely in suspected large vessel etiology ( = 0.02). Abnormal TTE lead to treatment change in 24 (5%) patients; 22/24 were started on anticoagulation. TTE results were less likely to influence treatment changes in older patients (71 [60-80] vs. 58 [49-69] years, = 0.02) with known atrial fibrillation ( = 0.01). Our findings suggest that despite widespread use, the overall yield of TTE in AIS is low. Stratifying patients according to their likelihood of benefitting from it will be important toward better resource utilization.
经胸超声心动图（TTE）作为标准急性缺血性卒中（AIS）检查的一部分常规进行。然而，TTE的总体诊断率尚不清楚，许多患者可能接受了不必要的检查。本研究旨在调查TTE作为AIS检查一部分的效用。我们收集了2016年7月1日至2017年9月30日期间入住我院的连续性AIS患者的数据。纳入患者的依据为神经影像学证实的AIS、年龄>18岁以及神经影像学检查。主要终点是TTE产生相关发现的病例比例，相关发现定义为房间隔缺损或卵圆孔未闭、左心房扩大、左心室血栓或射血分数<35%。次要终点是因TTE导致治疗方案改变的患者比例。在548例AIS患者（中位年龄71[59 - 81]岁，50%为女性）中，482例（87%）接受了TTE检查。183例（38%）患者观察到临床相关发现，41例（8.5%）患者因此进行了进一步检查。进一步检查与较年轻的中位年龄相关（58[50 - 65]岁 vs. 72[62 - 81]岁，<0.0001），在疑似大血管病因的患者中可能性较小（ = 0.02）。异常的TTE结果导致24例（5%）患者治疗方案改变；22/24例患者开始抗凝治疗。TTE结果在老年患者（71[60 - 80]岁 vs. 58[49 - 69]岁， = 0.02）和已知房颤患者（ = 0.01）中影响治疗方案改变的可能性较小。我们的研究结果表明，尽管TTE被广泛使用，但在AIS中的总体诊断率较低。根据患者从TTE中获益的可能性进行分层对于更好地利用资源很重要。
