常规经胸超声心动图在缺血性卒中或不明原因的短暂性缺血性发作中的应用:一项前瞻性多中心研究。

IF 1.7 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Netherlands Heart Journal Pub Date : 2024-02-01 Epub Date: 2023-10-23 DOI:10.1007/s12471-023-01819-7
Gerlinde van der Maten, Matthijs F L Meijs, Jorik R Timmer, Paul J A M Brouwers, Clemens von Birgelen, Jonathan M Coutinho, Berto J Bouma, Henk Kerkhoff, Anne Mijn Helming, Julia H van Tuijl, Nicolet A van der Meer, Ritu Saxena, Corné Ebink, Job van der Palen, Heleen M den Hertog
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引用次数: 0

摘要

背景:指南建议在缺血性中风或不明原因的短暂性缺血性发作后进行常规经胸超声心动图(TTE);然而,只有有限的科学证据存在。因此,我们旨在确定这些患者经胸超声心动图检测的主要心脏栓塞源(CSE)的患病率,这些栓塞是导致治疗变化的异常。方法:六家荷兰医院进行了一项前瞻性观察性研究,纳入了不明原因的缺血性中风或短暂性缺血性发作患者。患者在对卒中单位进行综合诊断评估后,包括血液化学、12导联心电图(ECG)、≥ 24 h连续心电图监测、大脑成像和颈动脉成像。主要结果指标是经胸超声心动图检测出主要CSE的患者比例。结果:从2018年3月到2020年10月,1084名患者,年龄66.6岁 ± 12.5岁,入组;456名(42.1%)患者为女性,869名(80.2%)患者为缺血性中风。TTE仅在11例(1.0%)患者中检测到严重CSE。这些患者中有10名(90.9%)也有严重的心电图异常(既往梗死、严重再极化异常或既往未知的左束支传导阻滞),无论卒中评估如何,都需要进行经胸超声心动图评估。此类心电图异常出现在总研究人群的11.1%中。尽管没有心电图异常,但有一名患者(0.1%)表现出严重的CSE。结论:这项多中心横断面研究针对在当代卒中单元检查后被诊断为缺血性卒中或不明原因的短暂性脑缺血发作的患者,发现经胸超声心动图仅在1%的患者中检测到主要CSE。这些患者中的大多数也有严重的心电图异常。这些发现对常规经胸超声心动图评估在这种临床环境中的价值提出了质疑。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Routine transthoracic echocardiography in ischaemic stroke or transient ischaemic attack of undetermined cause: a prospective multicentre study.

Background: Guidelines recommend routine transthoracic echocardiography (TTE) after ischaemic stroke or transient ischaemic attack of undetermined cause; yet, only limited scientific evidence exists. Therefore, we aimed to determine in these patients the prevalence of TTE-detected major cardiac sources of embolism (CSE), which are abnormalities leading to therapeutic changes.

Methods: Six Dutch hospitals conducted a prospective observational study that enrolled patients with ischaemic stroke or transient ischaemic attack of undetermined cause. Patients underwent TTE after comprehensive diagnostic evaluation on stroke units, including blood chemistry, 12-lead electrocardiogram (ECG), ≥ 24 h continuous ECG monitoring, brain imaging and cervical artery imaging. Primary outcome measure was the proportion of patients with TTE-detected major CSE.

Results: From March 2018 to October 2020, 1084 patients, aged 66.6 ± 12.5 years, were enrolled; 456 (42.1%) patients were female and 869 (80.2%) had ischaemic stroke. TTE detected major CSE in only 11 (1.0%) patients. Ten (90.9%) of these patients also had major ECG abnormalities (previous infarction, major repolarisation abnormalities, or previously unknown left bundle branch block) that would have warranted TTE assessment regardless of stroke evaluation. Such ECG abnormalities were present in 11.1% of the total study population. A single patient (0.1%) showed a major CSE despite having no ECG abnormality.

Conclusions: This multicentre cross-sectional study in patients who-after workup on contemporary stroke units-were diagnosed with ischaemic stroke or transient ischaemic attack of undetermined cause found TTE-detected major CSE in only 1% of all patients. Most of these patients also had major ECG abnormalities. These findings question the value of routine TTE assessment in this clinical setting.

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来源期刊
Netherlands Heart Journal
Netherlands Heart Journal CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
4.70
自引率
5.00%
发文量
84
审稿时长
6-12 weeks
期刊介绍: The scope of the Netherlands Heart Journal is to contribute to the national and international literature by publishing scientific papers in the field of cardiovascular medicine. It also provides a platform for Continuing Medical Education for cardiologists and those in training for the speciality of cardiology in the Netherlands. The Netherlands Heart Journal is made available to cardiologists, cardiologists in training, cardiopulmonary surgeons, cardiopulmonary surgeons in training, internists and paediatric cardiologists. The journal is the official journal of the Netherlands Society of Cardiology.
期刊最新文献
Cost-effectiveness of long term left ventricular assist devices. Reply to 'Cost-effectiveness of long term left ventricular assist devices'. The effects of spondylodiscitis on the inflammation burden in infective endocarditis. Growth rates in non-syndromic aneurysms of the ascending aorta: a systematic review. Advancing cardiovascular care-key insights from the Netherlands Heart Journal 2024.
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