Schnieder Marlena, Chebbok Mohammed, Didié Michael, Wolf Frieder, Badr Mostafa, Allam Ibrahim, Bähr Mathias, Hasenfuß Gerd, Liman Jan, Schroeter Marco Robin
Department for Cardiology & Pneumology/Heart Center, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany.
Department for Neurology, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany.
BMC Neurol. 2021 Mar 17;21(1):118. doi: 10.1186/s12883-021-02136-5.
Echocardiography is one of the main diagnostic tools for the diagnostic workup of stroke and is already well integrated into the clinical workup. However, the value of transthoracic vs. transesophageal echocardiography (TTE/TEE) in stroke patients is still a matter of debate. Aim of this study was to characterize relevant findings of TTE and TEE in the management of stroke patients and to correlate them with subsequent clinical decisions and therapies.
We evaluated n = 107 patients admitted with an ischemic stroke or transient ischemic attack to our stroke unit of our university medical center. They underwent TTE and TEE examination by different blinded investigators.
Major cardiac risk factors were found in 8 of 98 (8.2%) patients and minor cardiac risk factors for stroke were found in 108 cases. We found a change in therapeutic regime after TTE or TEE in 22 (22.5%) cases, in 5 (5%) cases TEE leads to the change of therapeutic regime, in 4 (4%) TTE and in 13 cases (13.3%) TTE and TEE lead to the same change in therapeutic regime. The major therapy change was the indication to close a patent foramen ovale (PFO) in 9 (9.2%) patients with TTE and in 10 (10.2%) patients with TEE (p = 1.000).
Major finding with clinical impact on therapy change is the detection of PFO. But for the detection of PFO, TTE is non inferior to TEE, implicating that TTE serves as a good screening tool for detection of PFO, especially in young age patients.
The trial was registered and approved prior to inclusion by our local ethics committee (1/3/17).
超声心动图是中风诊断检查的主要诊断工具之一，并且已很好地融入临床检查中。然而，经胸与经食管超声心动图（TTE/TEE）在中风患者中的价值仍存在争议。本研究的目的是描述TTE和TEE在中风患者管理中的相关发现，并将它们与后续的临床决策和治疗相关联。
我们评估了107例因缺血性中风或短暂性脑缺血发作入住我校医学中心中风单元的患者。他们由不同的盲法研究者进行了TTE和TEE检查。
98例患者中有8例（8.2%）发现主要心脏危险因素，108例发现中风的次要心脏危险因素。我们发现在22例（22.5%）患者中，TTE或TEE后治疗方案发生了改变，5例（5%）患者中TEE导致治疗方案改变，4例（4%）患者中TTE导致治疗方案改变，13例（13.3%）患者中TTE和TEE导致相同的治疗方案改变。主要的治疗改变是9例（9.2%）TTE患者和10例（10.2%）TEE患者中有指征关闭卵圆孔未闭（PFO）（p = 1.000）。
对治疗改变有临床影响的主要发现是PFO的检测。但对于PFO的检测，TTE并不逊于TEE，这意味着TTE可作为检测PFO的良好筛查工具，尤其是在年轻患者中。
该试验在纳入患者之前已由我们当地的伦理委员会注册并批准（1/3/17）。
