The value of transesophageal echocardiography in the investigation and management of cryptogenic cerebral ischemia: a single-center experience

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• 作者：Aristeidis H. Katsanos ; Dimitrios Patsouras ; Georgios Tsivgoulis…
• 关键词：Transesophageal echocardiography ; Anticoagulation ; Patent foramen ovale ; Aorta atheromatosis ; Cryptogenic stroke
• 刊名：Neurological Sciences
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：37
• 期：4
• 页码：629-632
• 全文大小：323 KB
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• 作者单位：Aristeidis H. Katsanos (1) (2)
  Dimitrios Patsouras (3)
  Georgios Tsivgoulis (4) (5) (6)
  Maria Kosmidou (7)
  Konstantinos H. Katsanos (8)
  Athanassios P. Kyritsis (1) (2)
  Sotirios Giannopoulos (1) (2)
  
  1. Department of Neurology, University of Ioannina School of Medicine, University Campus, Ioannina, 45110, Greece
  2. Neurosurgical Research Institute, University of Ioannina, Ioannina, Greece
  3. Department of Cardiology, “Hatzikosta” General Hospital, Ioannina, Greece
  4. Second Department of Neurology, “Attikon” University Hospital, School of Medicine, University of Athens, Athens, Greece
  5. Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
  6. International Clinical Research Center, St. Anne’s University Hospital in Brno, Brno, Czech Republic
  7. First Division of Internal Medicine, University of Ioannina School of Medicine, Ioannina, Greece
  8. Division of Gastroenterology, University of Ioannina School of Medicine, Ioannina, Greece
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Neurology
  Neuroradiology
  Neurosurgery
  Psychiatry
  
• 出版者：Springer Milan
• ISSN：1590-3478

文摘

The diagnostic utility of transesophageal echocardiography (TEE) has often been challenged in patients with cryptogenic stroke (CS). We estimated the prevalence of different findings on TEE examination of CS patients, their impact on secondary stroke prevention and the presence of potential age or gender disparities. We reviewed all TEE examinations that were performed in a single echocardiography laboratory during a 7-year-old period to identify CS patients that underwent investigation with TEE. Of the 518 total TEE examinations, we identified 88 CS patients. TEE revealed abnormal findings in 69.3 % of them. Patent foramen ovale (PFO) and atrial septal aneurysm (ASA) were identified in 30.6 and 22.7 % of the patients. Ascending aorta and aortic arch atheromatosis was present in 26.1 % of the patients, with complex atheromatosis diagnosed in 14.7 % of them. Cardiac myxomas were uncovered in 2.3 %. Thrombi in the left atrium and in cardiac valves were reported in 3.4 and 2.3 % of the patients, respectively. Based on TEE findings, the therapeutic management would be very likely modified in 9.1 % of the patients. Subgroup analysis revealed no gender disparities on the prevalence of TEE findings and in secondary stroke prevention, while linear regression analyses revealed significant associations of age with the prevalence of PFO, ASA, aorta atheromatosis and complex aorta atheromatosis. TEE examination should be included in the diagnostic work-up of all CS patients, irrespective of age and gender status, since it can reveal potential sources of embolism and has a significant impact for secondary stroke prevention.