Rauh R, Fischereder M, Spengel F A
Medizinische Poliklinik, München, Germany.
Stroke. 1996 Apr;27(4):691-4. doi: 10.1161/01.str.27.4.691.
Identification of cardioembolic stroke is often limited by the difficulties involved in the detection of thrombi or the risk factors for thrombus formation. Patients in sinus rhythm with nondiagnostic transthoracic echocardiogram (TTE) and without carotid artery stenosis represent a subset in whom diagnostic recommendations are lacking. The aim of this study was to determine the value of transesophageal echocardiography (TEE) for diagnosis and therapy in this population.
Thirty patients with the characteristics described above were studied prospectively with the use of blood analysis, TTE, TEE, and Holter monitoring (in patients with atrial thrombus).
TTE was abnormal in 16 of 30 patients, but no embolic source was identified. TEE disclosed left atrial appendage thrombus in 3 of 30 patients, atrial septal aneurysm in 2 of 30 patients, patent foramen ovale in 7 of 30 patients, and aortic plaques in 19 of 30 patients. The Tee resulted in a change of therapy in 3 of the 30 patients studied.
This study demonstrates that TEE is a helpful diagnostic tool in delineating the risk of cardioembolic stroke and demonstrates significant pathology even in a subset of patients deemed to be at low risk. This additional new information led to a substantial change in therapy in 3 of 30 patients.
心源性脑栓塞性卒中的识别常常受到血栓检测或血栓形成危险因素相关困难的限制。窦性心律、经胸超声心动图（TTE）检查无诊断价值且无颈动脉狭窄的患者是一类缺乏诊断建议的亚组人群。本研究的目的是确定经食管超声心动图（TEE）在该人群诊断和治疗中的价值。
对30例具有上述特征的患者进行前瞻性研究，采用血液分析、TTE、TEE及动态心电图监测（适用于有心房血栓的患者）。
30例患者中16例TTE检查异常，但未发现栓子来源。TEE检查发现30例患者中有3例左心耳血栓、2例房间隔瘤、7例卵圆孔未闭及19例主动脉斑块。在30例接受研究的患者中，TEE检查导致3例患者治疗方案改变。
本研究表明，TEE是确定心源性脑栓塞性卒中风险的有用诊断工具，即使在被认为是低风险的部分患者中也显示出显著病变。这些额外的新信息导致30例患者中有3例治疗方案发生重大改变。
