Therapy Implications of Transthoracic Echocardiography in Acute Ischemic Stroke Patients

Abreu, Tiago Tribolet de; Mateus, Sónia; Correia, J. Pinto

doi:10.1161/01.str.0000170636.08554.49

Cited by 54 publications

(44 citation statements)

References 13 publications

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“…AF dışındaki diğer KE olayların tespit edilmesinde temel yöntem ekokardiyografi önemli bir testtir ve tüm iskemik inmeli hastalarda TTE temel test olmalıdır kanısına varılmıştır (16). Bunun yanında TEE TTE'nin bir üst değerlendirme basamağı kabul edilmiş ve TEE sonucunda iskemik inmeli hastaların %40-60 arasında bir KE kaynak tespit edilmiştir (17,18).…”

Section: Discussionunclassified

The Role and Significance of Cardiac and Carotid Pathologies in Ischemic Stroke Etiology

Koyuncu¹,

Cander²,

Girisgin³

et al. 2011

JAEM

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GirişSerebro vasküler hastalıklar (SVH) beynin bir veya birden çok kan damarının katıldığı patolojik süreçler sonucu oluşan ani başlangıçlı, fokal veya global nörolojik semptomlar olarak tanımlanır. Patolojik süreç, damar duvarının herhangi bir lezyonu veya permiabilite değişik-liği, lümenin emboli veya trombüs ile tıkanması, damarların rüptürü, kan viskozitesinde artış veya diğer kan içeriğindeki değişiklikler, ateroskleroz, hipertansif aterosklerotik değişiklikler, anevrizmal dilatasyon, arterit, gelişimsel malformasyonlar gibi durumlarda gelişir (1, 2).Akut inme tedavisindeki gelişmelere rağmen, inme nedenli ölümler halen birçok ülkede 3. sırada yer almaktadır. İnme ayrıca önde gelen engelli olma nedenidir. Yaşayanların %20'si, 3 hafta hastane bakımına ihtiyaç duymakta %15-33 kadarı sürekli özürlü kalmaktadır. Bu durum hastanın ve ailesinin ekonomik, sosyal, psikolojik hayatı ve genel yaşam kalitesi üzerine olumsuz etki oluşturmaktadır. Bu hastaların sürekli bakım ve tedavi masrafları, kişiye ve topluma ciddi mali yük getirmektedir. Aile bireylerinin neredeyse yarısı bu olayı ölümden kötü görmektedirler. Bu durumda inme açısından risk oluşturan faktörlerin epidemiyolojik çalışmalarla belirlenmesi ve önlenmesi önem kazanmaktadır (3).İnme, acil nöroloji servislerine başvuran bütün vakaların %50'sini, kronik bakım servislerinde yatan vakaların %15'ini oluş-turmaktadır (3). AbstractObjective: Stroke is the third leading cause of death and the commonest cause of adult disability in both developed and developing countries. Immediate mortality is high and approximately 30% of stroke patients die within a year and one in three of stroke patients become dependent on others. In this study on cardiac and carotid pathology, was designed to investigate the importance of ischemic stroke. Materials and Methods:The data of 91 patients with acute ischemic stroke who were admitted to the emergency department of Selcuk University from 01/2007 to 01/2008 were analyzed. All the patients were evaluated with echocardiography and carotid arterial doppler. Results: According to TOAST criteria, all patients with acute ischemic stroke are classified as; 29.7% large vessel disease, 40.7% cardioembolic stroke, 18.7% small vessel disease, 4.4% other known etiologies and 10.5% unknown causes. With echocardiographic evaluation, the high risk of cardioembolic stroke is 21.1% and intermediate risk of cardioembolic stroke is 76.6.% With carotid arterial doppler evaluation 38.5% patients have <50% stenosis, 18.7% patients have 50-70% stenosis, 7.7% patients have >70% stenosis and 3.3% have total occlusion. Conclusion: The echocardiographic evaluation is mandatory for the diagnosis and choice of treatment options for all patients who have ischemic stroke, and the carotid arterial doppler is an essential study mode for this population. (JAEM 2011; 10: 114-8)

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Section: Discussionunclassified

The Role and Significance of Cardiac and Carotid Pathologies in Ischemic Stroke Etiology

Koyuncu¹,

Cander²,

Girisgin³

et al. 2011

JAEM

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“…Thrombogenicity is a strong candidate for anticoagulation in patients with suspected cardioembolism [2]. Our results show that reduced LVEF on TTE needs to have anticoagulation [6]. …”

Section: Discussionmentioning

confidence: 99%

“…Moreover, only 15–20% of embolic strokes are proven to be of cardiac origin [5]. It is controversial that echocardiography is an essential test in all ischemic stroke patients [6, 7]. Furthermore, there are few criteria whether to perform TEE in patients with suspected embolic stroke.…”

Section: Introductionmentioning

confidence: 99%

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Mild Left Ventricular Dysfunction Is Associated with Thrombogenicity in Cardioembolic Stroke

et al. 2006

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Background: Transesophageal echocardiography (TEE) has been recognized as a valuable tool for identifying the left cardiac thrombus (LCT) or spontaneous echocardiographic contrast (SEC). We aimed to identify risk groups where TEE should be performed in patients with suspected cardioembolic stroke according to magnetic resonance imaging analysis. Methods: One hundred and forty-six patients (mean age 64.7 ± 11.8 years, 101 males) with suspected cardioembolic stroke were analyzed. We used TEE for the presence of LCT and/or SEC as indication of thrombogenicity. We evaluated the association between thrombogenicity and demographic features, stroke risk factors and echocardiographic variables. Results: The study included 40 patients (27.3%) who showed thrombogenicity (10 LCT and 30 SEC). The independent echocardiographic variables of thrombogenicity were atrial fibrillation (OR 7.14; 95% CI 2.62–19.48; p < 0.001) and left ventricular ejection fraction ≤50% (OR 4.01; 95% CI 1.40–11.49; p = 0.01). Conclusion: We recommend that TEE should be considered in patients with mildly reduced left ventricular dysfunction (ejection fraction ≤50%) after suspected cardioembolic stroke.

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“…Even more challenging are findings with uncertain optimal management strategies, such as PFO, atrial septal aneurysm (ASA), lone spontaneous echo contrast (SEC), a low ejection fraction, and aortic arch atheroma. Reported therapeutic yield for echocardiography in stroke patients ranges widely, from 2% to 37.2% for TTE 28,32,33 and 8% to 32% for TEE. 34,35,36 These inconsistencies are attributable to differences in study design, such as retrospective versus prospective data, consecutive versus referred patients, patient selection by characteristics such as age, history of cardiac disease or stroke subtype, how a cardiac SOE is defined, and what is considered an indication for OAC.…”

Section: The Therapeutic Yield Of Echocardiographymentioning

confidence: 99%

Cardiac Workup of Ischemic Stroke

Morris

Duffis

Fisher

2009

Stroke

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Background and Purpose-Discovering potential cardiac sources of stroke is an important part of the urgent evaluation of the ischemic stroke patient as it often impacts treatment decisions that are essential for determining secondary stroke prevention strategies, yet the optimal approach to the cardiac workup of an ischemic stroke patient is not known. Methods-A review of the literature concerning the utility of cardiac rhythm monitoring (ECG, telemetry, Holter monitors, and event recorders) and structural imaging (transthoracic and transesophageal echocardiography) was performed. Results-Data supporting a definitive, optimal, and cost-effective approach are lacking, though some data suggest that appropriate patient selection can improve the diagnostic and therapeutic yield of rhythm monitoring and echocardiography in the evaluation of stroke etiology. Conclusions-Based on available data, an algorithmic approach for the evaluation of patients with acute ischemic cerebrovascular events that takes into account therapeutic and diagnostic yield as well as cost-efficiency is proposed.

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Therapy Implications of Transthoracic Echocardiography in Acute Ischemic Stroke Patients

Cited by 54 publications

References 13 publications

The Role and Significance of Cardiac and Carotid Pathologies in Ischemic Stroke Etiology

The Role and Significance of Cardiac and Carotid Pathologies in Ischemic Stroke Etiology

Mild Left Ventricular Dysfunction Is Associated with Thrombogenicity in Cardioembolic Stroke

Cardiac Workup of Ischemic Stroke

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