Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, United States.
Handb Clin Neurol. 2021;177:359-375. doi: 10.1016/B978-0-12-819814-8.00022-6.
Echocardiography employs ultrasound to evaluate cardiac function, structure and pathology. The clinical value in secondary ischemic stroke prevention depends on identification of associated conditions for which a change in treatment from antiplatelet agents and risk factor intervention leads to improved outcomes. Such therapeutically relevant findings include primarily intracardiac thrombus, valvular heart disease and, in highly selected patients, patent foramen ovale (PFO). Echocardiography in unselected patients with ischemic stroke has a very low yield of therapeutically relevant findings and is not cost-effective. With the exception of PFO, findings on echocardiography that are therapeutically relevant for secondary stroke prevention are almost always associated with history, signs or symptoms of cardiac or systemic disease. Choice of specific echocardiographic modalities should be based on the specific pathology or pathologies that are under consideration for the individual clinical situation. Transthoracic echocardiography (TTE) with agitated saline has comparable accuracy to transesophageal echocardiography (TEE) for PFO detection. For other therapeutically relevant pathologies, with the possible exception of left ventricular thrombus (LVT), TEE is more sensitive than TTE. Professional societies recommend TTE as the initial test but these recommendations do not take cost into account. In contrast, cost-effectiveness studies have determined that the most sensitive echocardiographic modality should be selected as the initial and only test.
超声心动图利用超声波来评估心脏功能、结构和病理。在二级预防缺血性卒中方面的临床价值取决于相关情况的识别，改变抗血小板药物治疗和危险因素干预可改善结局。此类有治疗意义的发现主要包括心腔内血栓、心脏瓣膜病，以及在高度选择的患者中，卵圆孔未闭（PFO）。对缺血性卒中的未选择患者进行超声心动图检查，有治疗意义的发现的检出率非常低，且不具成本效益。除了 PFO 以外，超声心动图上对二级卒中预防有治疗意义的发现几乎总是与心脏或全身疾病的病史、体征或症状相关。具体超声心动图模式的选择应基于个体临床情况中考虑的具体病理变化。含对比剂的经胸超声心动图（TTE）与经食管超声心动图（TEE）在检测 PFO 方面的准确性相当。对于其他有治疗意义的病理变化，除了左心室血栓（LVT）以外，TEE 比 TTE 更敏感。专业学会推荐 TTE 作为初始检查，但这些推荐没有考虑成本。相比之下，成本效益研究已经确定，应选择最敏感的超声心动图模式作为初始和唯一的检查。
