500例有潜在心脏或颈动脉栓子来源患者及正常对照者的颅内微栓塞信号

Intracranial microembolic signals in 500 patients with potential cardiac or carotid embolic source and in normal controls.

作者信息

Georgiadis D, Lindner A, Manz M, Sonntag M, Zunker P, Zerkowski H R, Borggrefe M

机构信息

Department of Neurology, University of Halle, Germany.

出版信息

Stroke. 1997 Jun;28(6):1203-7. doi: 10.1161/01.str.28.6.1203.

DOI:10.1161/01.str.28.6.1203

PMID:9183352

Abstract

BACKGROUND AND PURPOSE

We undertook this study to evaluate the prevalence and clinical correlations of Doppler microembolic signals (MES) in stroke-prone patients.

METHODS

Patients with potential cardiac (n = 300) or carotid (n = 100) embolic source and control subjects (n = 100) were monitored with transcranial Doppler sonography for MES. Transthoracic (n = 192) and/or transesophageal (n = 134) echocardiography and carotid studies (continuous-wave Doppler, n = 181; color-coded duplex, n = 47) were performed in all patients with potential native cardioembolic source. Carotid disease was evaluated by means of continuous-wave Doppler (n = 87), color-coded duplex (n = 70), or intra-arterial angiography (n = 24) in patients with potential carotid embolic source.

RESULTS

Overall MES prevalence was 23% in patients with potential native cardioembolic source (infective endocarditis [n = 7] 43%, left ventricular aneurysm [n = 38] 34%, intracardiac thrombus [n = 23] 26%, dilative cardiomyopathy [n = 39] 26%, nonvalvular atrial fibrillation [n = 24] 21%, valvular disease [n = 80] 15%), 55% in patients with prosthetic cardiac valves (mechanical [n = 77] 58%, porcine [n = 7] 43%, homografts [n = 5] 20%), 28% in patients with carotid disease (symptomatic [n = 46] 52%, asymptomatic [n = 54] 7%; P < .01), and 5% in control subjects. No relationship between MES counts and patients' age, sex, or actual medication was noted. The sensitivity and specificity of MES detection in identifying patients with potential embolic sources were 31% and 95%, respectively.

CONCLUSIONS

Our study confirmed the reported clinical significance of MES in patients with carotid disease and the high specificity of this technique. The demonstrated low sensitivity of MES detection could be due to short monitoring duration or application of antihemostatic treatment. Prospective large-scale studies are needed to determine the definitive value of MES detection as a diagnostic method in patients with potential cardioembolic source.

摘要

背景与目的

我们开展本研究以评估易患卒中患者中多普勒微栓子信号（MES）的发生率及其临床相关性。

方法

对有潜在心脏（n = 300）或颈动脉（n = 100）栓子来源的患者以及对照受试者（n = 100）进行经颅多普勒超声监测以检测MES。对所有有潜在心源性栓子来源的患者进行经胸（n = 192）和/或经食管（n = 134）超声心动图检查以及颈动脉检查（连续波多普勒，n = 181；彩色编码双功超声，n = 47）。对有潜在颈动脉栓子来源的患者通过连续波多普勒（n = 87）、彩色编码双功超声（n = 70）或动脉内血管造影（n = 24）评估颈动脉疾病。

结果

有潜在心源性栓子来源的患者中MES总体发生率为23%（感染性心内膜炎[n = 7] 43%，左心室动脉瘤[n = 38] 34%，心内血栓[n = 23] 26%，扩张型心肌病[n = 39] 26%，非瓣膜性心房颤动[n = 24] 21%，瓣膜病[n = 80] 15%），人工心脏瓣膜患者中为55%（机械瓣膜[n = 77] 58%，猪瓣膜[n = 7] 43%，同种异体移植物[n = 5] 20%），颈动脉疾病患者中为28%（有症状者[n = 46] 52%；无症状者[n = 5] 7%；P <.01），对照受试者中为5%。未发现MES计数与患者年龄、性别或实际用药之间存在关联。MES检测在识别有潜在栓子来源患者中的敏感性和特异性分别为31%和95%。