Department of Neurology, Medisch Spectrum Twente, Koningstraat 1, 7512 KZ Enschede, the Netherlands; Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522 NB Enschede, the Netherlands.
Department of Neurology, Medisch Spectrum Twente, Koningstraat 1, 7512 KZ Enschede, the Netherlands.
Int J Cardiol. 2021 Sep 15;339:211-218. doi: 10.1016/j.ijcard.2021.06.047. Epub 2021 Jun 29.
Patients with ischemic stroke or transient ischemic attack (TIA) of undetermined cause often undergo cardiac imaging in search of a cardioembolic source. As the choice of the most appropriate imaging approach is controversial and therapeutic implications have changed over time, we aimed to identify in patients with "cryptogenic stroke or TIA" the yield of transthoracic or transesophageal echocardiography (TTE or TEE) and cardiac computed tomography (CT).
We performed a systematic review and meta-analysis according to the PRISMA guidelines. Included were studies that assessed consecutive patients with ischemic stroke or TIA of undetermined cause to evaluate the yield of TTE, TEE, or cardiac CT for detecting cardioembolic sources. For each type of cardioembolic source the pooled prevalence was calculated. Only six out of 1458 studies fulfilled the inclusion criteria (1022 patients). One study reported the yield of TTE, four of TEE, and one of both TTE and TEE; no study assessed cardiac CT. Mean patient age ranged from 44.3-71.2 years, 49.2-59.7% were male. TTE detected 43 cardioembolic sources in 316 patients (4 (1.3%) major, 39 (12.3%) minor), and TEE 248 in 937 patients (55 (5.9%) major, 193 (20.6%) minor). The most prevalent major cardioembolic source was left atrial appendage thrombus, yet results were heterogeneous among studies.
TTE and TEE infrequently detect major cardioembolic sources that require a change of therapy. Findings should be interpreted with caution due to the limited number of studies. A large-sized prospective clinical trial is warranted to support evidence-based decision-making.
患有不明原因缺血性脑卒中或短暂性脑缺血发作（TIA）的患者通常会进行心脏影像学检查，以寻找心源性栓塞源。由于选择最合适的影像学方法存在争议，且治疗意义随时间而变化，我们旨在确定在“隐匿性脑卒中或 TIA”患者中，经胸超声心动图（TTE）或经食管超声心动图（TEE）和心脏计算机断层扫描（CT）的检出率。
我们根据 PRISMA 指南进行了系统评价和荟萃分析。纳入的研究评估了连续的不明原因缺血性脑卒中或 TIA 患者，以评估 TTE、TEE 或心脏 CT 检测心源性栓塞源的检出率。对于每种类型的心源性栓塞源，计算了汇总患病率。在 1458 项研究中，仅有 6 项（1022 例患者）符合纳入标准。1 项研究报告了 TTE 的检出率，4 项研究报告了 TEE 的检出率，1 项研究报告了 TTE 和 TEE 的检出率；没有研究评估心脏 CT。患者平均年龄为 44.3-71.2 岁，49.2-59.7%为男性。TTE 在 316 例患者中检出 43 个心源性栓塞源（4 个（1.3%）为主要源，39 个（12.3%）为次要源），TEE 在 937 例患者中检出 248 个（55 个（5.9%）为主要源，193 个（20.6%）为次要源）。最常见的主要心源性栓塞源是左心耳血栓，但研究结果存在异质性。
TTE 和 TEE 很少能检测到需要改变治疗的主要心源性栓塞源。由于研究数量有限，结果应谨慎解释。需要进行一项大型前瞻性临床试验，以支持基于证据的决策。
