Should Routine Echocardiography Be Performed in All Patients With Stroke?

Wölber, Thomas; Maeder, Micha T.; Atefy, Ramin; Blužaitė, Ina; Blank, Robert; Rickli, Hans; Ammann, Peter

doi:10.1016/j.jstrokecerebrovasdis.2006.07.002

Cited by 47 publications

(41 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…At present, there is not enough evidence in the literature to recommend anticoagulation therapy over aspirin in patients with medium-risk factors; therefore, TEE does not provide therapeutic gains in terms of medical treatment. [21][22][23][24] Furthermore, the diagnostic performance of the CCTA for detecting medium-risk sources was improved in a per-patient analysis.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Computed Tomographic Angiography for Detection of Cardiac Sources of Embolism in Stroke Patients

Hur

Kim

Lee

et al. 2009

Stroke

View full text Add to dashboard Cite

Background and Purpose-We assessed the diagnostic performance of 2-phase 64-slice cardiac computed tomographic angiography (CCTA) for the detection of a cardiac source of embolism in stroke patients using transesophageal echocardiography (TEE) as the reference standard. Methods-We selected 137 patients who had experienced a recent episode of stroke and had undergone both 2-phase 64-slice CCTA and TEE within a period of 5 days. A potential cardiac source of embolism detected at both CCTA and TEE was recorded, and echocardiographic findings were categorized into high-and medium-risk sources based on the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification. Results-Of 137 patients, 100 abnormal findings in 91 patients were found on TEE, and 46 patients had no abnormal finding on TEE. The overall sensitivity, specificity, positive predictive value, and negative predictive value of the 64-slice CCTA for detecting cardiac sources of embolism were 89% (95% CI, 82%, 95%), 100% (95% CI, 90%, 100%), 100% (95% CI, 95%, 100%), and 81% (95% CI, 70%, 92%), respectively. TEE detected a total of 47 high-risk sources of embolism, whereas CT detected 44 lesions. For medium-risk sources of cardiac embolic stroke, TEE detected a total of 53 abnormal findings, whereas CT detected 44 abnormal findings. Of 53 lesions, there were 8 false-negative results on CT (5 patent foramen ovale and 3 atrial septal aneurysm). Conclusions-Two-phase 64-slice CCTA is a noninvasive and useful modality for detecting high-risk cardiac sources of embolism in stroke patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Cardiac Computed Tomographic Angiography for Detection of Cardiac Sources of Embolism in Stroke Patients

Hur

Kim

Lee

et al. 2009

Stroke

View full text Add to dashboard Cite

show abstract

“…Este resultado vai de encontro ao de outros autores que também evidenciaram uma influência dos achados do ETE na subsequente estratégia terapêutica escolhida, principalmente nos doentes jovens 4,19 .…”

Section: O S I G N I F I C a D O D E M U I T O S D O S A C H A D O S unclassified

“…Estima-se que cerca de 80 % dos AVC's sejam de natureza isquémica, dos quais aproximadamente 30 a 50 % de etiologia embólica cardíaca [3][4][5] .…”

Section: Introductionunclassified

“…Após o reconhecimento da superioridade diagnóstica do ETE, alguns autores ainda questionaram a utilidade do ETE para a orientação terapêutica dos doentes com AVC ou AIT 8 . Pelo contrário, estudos mais recentes evidenciaram uma infl uência do ETE na defi nição da estratégia terapêutica 4,9 . Após um evento isquémico cerebral, as opções terapêuticas a longo prazo têm sido a hipocoagulação ou anti-agregação plaquetária, sendo que esta última pode ainda ser simples ou dupla.…”

Section: Introductionunclassified

“…Atendendo aos diferentes perfi s risco/benefício das terapêuticas disponíveis, o tratamento escolhido deve permitir a maior protecção possível para o menor risco hemorrágico associado. No entanto, deve ser salientado que ainda existe controvérsia sobre o tratamento mais adequado em certas situações, como as placas complexas de ateroma na aorta e o foramen ovale patente (FOP), para os quais ainda não existem estratégias terapêuticas baseadas na evidência 4 . Assim alguns achados diagnósticos do ETE são ainda de signifi cado incerto quanto à orientação terapêutica.…”

Section: Introductionunclassified

See 2 more Smart Citations