Aquilina M, Oldani A, Limonetti P, Milandri M
Servizio di Cardiologia, Ospedale Pierantoni, U.S.L. 38, Forlì.
G Ital Cardiol. 1995 Jan;25(1):27-41.
Cardioembolism is the cause of cerebral infarct in 15 to 30% of cases. The aim of the present work is to detect, by transesophageal echocardiography (TEE), potential cardioembolic sources in patients with cerebral ischemia without atherosclerotic carotid disease at duplex carotid ultrasound examination.
From 1991 onwards, 420 consecutive patients who presented with cerebral ischemia, detected by computerized axial tomography, underwent an echotomography examination of the cerebral afferent vessels and a transthoracic echocardiogram (TTE). Three hundred and thirty out of these patients were excluded since they had carotid plaques; of the remaining 90, 80 (mean age 61.6 years range: 25-86, 50 males and 30 females) underwent a transesophageal examination. The patients were studied with an HP Sonos 1000 system with 2.5 and 3.5 MHz frequency probes for TTE; 7.5 and 5 MHz probes were used for echotomography and TEE respectively.
The TEE identified cardioembolic sources in 81% of the cases, versus 46.2% using TTE (p < 0.0001) with a significant statistical difference for thrombus, spontaneous echo contrast and paradoxic shunt (p < 0.0001). When the patients with cerebral ischemic events (group A) were compared with the 156 cardiac patients (group B) (mean age: 59.7, range: 19-86, 92 males and 64 females), without ischemic events, group A showed a significant higher prevalence of thrombus, spontaneous echo contrast, calcification of the mitral anulus, interatrial aneurysm and paradoxic shunt.
Our experience confirms that TEE is very useful and more sensitive than TTE for diagnosing cardioembolic sources; so, this new diagnostic tool should become a useful part of the diagnostic iter for patients with ischemic stroke and normal carotid vessels. The prevalence of some heart conditions in the stroke group poses the problem of whether to advise anticoagulant or antiplatelet therapy and, in selected cases, a surgical approach. The absence of heart and vascular conditions in the extracranial regions of patients who have had a cerebral stroke, suggests an intracranial condition and the problem of performing an angiographic examination arises.
心源性栓塞是15%至30%的脑梗死病例的病因。本研究的目的是通过经食管超声心动图（TEE）检测在双功颈动脉超声检查中无动脉粥样硬化性颈动脉疾病的脑缺血患者的潜在心源性栓子来源。
从1991年起，420例经计算机断层扫描检测出脑缺血的连续患者接受了脑传入血管的超声断层检查和经胸超声心动图（TTE）检查。其中330例患者因有颈动脉斑块而被排除；其余90例患者中，80例（平均年龄61.6岁，范围：25 - 86岁，男性50例，女性30例）接受了经食管检查。使用惠普Sonos 1000系统，分别用2.5和3.5MHz频率探头进行TTE检查；用7.5MHz和5MHz探头分别进行超声断层检查和TEE检查。
TEE在81%的病例中发现了心源性栓子来源，而TTE为46.2%（p < 0.0001），在血栓、自发回声增强和矛盾分流方面有显著统计学差异（p < 0.0001）。将发生脑缺血事件的患者（A组）与156例无缺血事件的心脏病患者（B组）（平均年龄：59.7岁，范围：19 - 86岁，男性92例，女性64例）进行比较时，A组血栓、自发回声增强、二尖瓣环钙化、房间隔瘤和矛盾分流的患病率显著更高。
我们的经验证实，TEE在诊断心源性栓子来源方面非常有用且比TTE更敏感；因此，这种新的诊断工具应成为颈动脉血管正常的缺血性卒中患者诊断流程中的有用部分。卒中组中某些心脏疾病的患病率引发了是否建议进行抗凝或抗血小板治疗的问题，以及在特定病例中是否采用手术方法的问题。脑卒中患者颅外区域无心脏和血管疾病提示颅内病变，从而引发了进行血管造影检查的问题。
