Top

Gepubliceerd in:

01-10-2009 | Original article

Influence of transoesophageal echocardiography on therapy and prognosis in young patients with TIA or ischaemic stroke

Auteurs: T. C. D. Rettig, B. J. Bouma, R. B. A. van den Brink

Gepubliceerd in: Netherlands Heart Journal | Uitgave 10/2009

Abstract

Objective. To determine the influence of transoesophageal echocardiography (TEE) on therapy and prognosis in patients with cryptogenic transient ischaemic attack (TIA) or ischaemic stroke under the age of 50 years.

Methods and results. We evaluated all patients aged 50 and under who were referred to our university hospital for cryptogenic TIA or ischaemic stroke during the period 1 January 1996 to 31 December 2004. All patients underwent both transthoracic echocardiography (TTE) and TEE. Patients with known pre-existent heart disease, such as atrial fibrillation, were excluded. Eighty-three patients with TIA (22) and ischaemic stroke (61) were enrolled. Mean age was 39±8 years (range 18 to 50). In 30% of the patients TEE detected one or more potential cardioembolic source, compared with 10% for TTE (p=0.003). Standard treatment (aspirin 38 mg daily) was changed in 7% of the patients due to the TEE findings. Complete followup was obtained in 93% with an average of 5±3 years. Twelve recurrences occurred; two out of six patients (33%) with therapy change and ten out of 71 (14%) of the patients without therapy change had a recurrent TIA or ischaemic Stroke.

Conclusion. In patients with cryptogenic TIA or ischaemic stroke, TEE is superior to TTE in the detection of a potential cardiac source of embolism. However, findings obtained by TEE only influence the already initiated treatment in a small percentage of patients. The recurrence rate both in the group with and without therapy change is high. (Neth Heart J 2009;17:373–7.)

vorige artikel Pulmonary vein isolation of symptomatic refractory paroxysmal and persistent atrial fibrillation

volgende artikel Therapeutic mild hypothermia improves outcome after out-of-hospital cardiac arrest

Yonemura K, Kimura K, Hasegawa Y, Yokota C, Minematsu K, Yamaguchi T. Analysis of ischemic stroke in patients aged up to 50 years. Rinsho Shinkeigaku. 2000;40:881–6.

Cerrato P, Grasso M, Imperiale D, Priano L, Baima C, Giraudo M, et al. Stroke in young patients: etiopathogenesis and risk factors in different age classes. Cerebrovasc Dis. 2004;18:154–9.

Asinger RW, Dyken ML, Fisher M, Harrison MJG, Hart RG, Sherman DG. Cardiogenic brain embolism. The second report of the Cerebral Embolism Task Force. Arch Neurol. 1989;46:727–43.

Flemming KD, Brown RD, Pety GW, Huston J 3rd, Kallmes DF, Piepgrad DG. Evaluation and Management of Transient Ischemic Attack. Mayo Clin Proc. 2004;79:1071–86.

Harloff A, Handke M, Reinhard M, Geibel A, Hetzel A. Therapeutic Strategies After Examination by Transesophageal Echocardiography in 503 Patients With Ischemic Stroke. Stroke. 2006;37:859–64.

Ward RP, Don CW, Furlong KT, Lang RM. Predictors of Long-Term Mortality in Patients With Ischemic Stroke Referred for Transesophageal Echocardiography. Stroke. 2006;37:204–8.

Kapral MK, Silver FL. Preventive health care, 1999 update: 2. Echocardiography for the detection of a cardiac source of embolus in patients with stroke. Canadian Task Force on Preventive Health Care. CMAJ. 1999;161:989–96.

Leung DY, Black IW, Cranney GB, Walsh WF, Grimm RA, Stewart WJ, et al. Selection of patients for transesophageal echocardiography after stroke and systemic embolic events. Role of transthoracic echocardiography. Stroke. 1995;26:1820–4.

Warner MF, Momah KI. Routine transesophageal echocardiography for cerebral ischemia. Is it really necessary? Arch Intern Med. 1996;156:1719–23.

10.

Cujec B, Polasek P, Voll C, Shuaib A. Transesophageal echocardiography in the detection of potential cardiac source of embolism in stroke patients. Stroke. 1991;22:727–33.

11.

Rauh R, Fischereder M, Spengel FA. Transesophageal echocardiography in patients with focal cerebral ischemia of unknown cause. Stroke. 1996;27:691–4.

12.

Kizer JR, Devereux RB. Patent foramen ovale in young adults with unexplained stroke. N Engl J Med. 2005;353:2361–72.

13.

Rabinstein AA, Chirinos JA, Fernandez FR, Zambrano JP. Is TEE useful in patients with small subcortical strokes?. Eur J Neurol. 2006;13:522–7.

14.

DeRook FA, Comess KA, Albers GW, Popp RL. Transesophageal echocardiography in the evaluation of stroke. Ann Intern Med. 1992;117:922–32.

15.

Ay H, Furie KL, Singhal A, Smith WS, Sorensen AG, Koroshetz WJ. An evidence-based causative classification system for acute ischemic stroke. Ann Neurol. 2005;58:688–97.

16.

Blackshear JL, Baker VS, Rubino F, Safford R, Lane G, Flipse T, et al. Adjusted-dose warfarin versus low-intensity, fixed-dose warfarin plus aspirin for high-risk patients with atrial fibrillation: Stroke Prevention in Atrial Fibrillation III randomised clinical trial. Lancet. 1996;348:633–8.

17.

Khairy P, O'Donnell CP, Landzberg MJ. Transcatheter Closure versus Medical Therapy of Patent Foramen Ovale and Presumed Paradoxical Thromboemboli. A Systematic Review. Ann Intern Med. 2003;139:753–60.

18.

Cujec B, Polasek P, Voll C, Shuaib A. Transesophageal echocardiography in the detection of potential cardiac source of embolism in stroke patients. Stroke. 1991;22:727–33.

19.

Hata JS, Ayres RW, Biller J, Adam HP Jr, Stuhlmuller JE, Burns TL et al. Impact of transesophageal echocardiography on the anticoagulation management of patients admitted with focal cerebral ischemia. Am J Cardiol. 1993;72:707–10.

20.

Marini C, Totaro R, Carolei A. Long-term prognosis of cerebral ischemia in young adults. National Research Council Study Group on Stroke in the Young. Stroke. 1999;30:2320–5.

21.

Varona JF, Bermejo F, Guerra JM, Molina JA. Long-term prognosis of ischemic stroke in young adults. Study of 272 cases. J Neurol. 2004;251:1507–1.

22.

Leys D, Bandu L, Henon H, Lucas C, Mounier-Vehier F, Rondepierre P, et al. Clinical outcome in 287 consecutive young adults (15 to 45 years) with ischemic stroke. Neurology. 2002; 59:26–33.

23.

Homma S, Sacco RL, Di Tullio MR, Sciacca RR, Mohr JP. Effect of medical treatment in stroke patients with patent foramen ovale: patent foramen ovale in Cryptogenic Stroke Study. Circulation. 2002;105:2625–31.

24.

Ranoux D, Cohen A, Cabanes L, Amarenco P, Bousser MG, Mas JL. Patent foramen ovale: is stroke due to paradoxical embolism? Stroke. 1993;24:31–4.

25.

Nighoghossian N, Perinetti M, Barthelet M, Adeleine P, Trouillas P. Potential cardioembolic sources of stroke in patients less than 60 years of age. Eur Heart J. 1996;17:590–4.

Titel: Influence of transoesophageal echocardiography on therapy and prognosis in young patients with TIA or ischaemic stroke
Auteurs: T. C. D. Rettig
B. J. Bouma
R. B. A. van den Brink
Publicatiedatum: 01-10-2009
Uitgeverij: Bohn Stafleu van Loghum
Gepubliceerd in: Netherlands Heart Journal / Uitgave 10/2009
Print ISSN: 1568-5888
Elektronisch ISSN: 1876-6250
DOI: https://doi.org/10.1007/BF03086287

Bohn Stafleu van Loghum

Deel dit onderdeel of sectie (kopieer de link)

Abstract

Log in om toegang te krijgen

Andere artikelen Uitgave 10/2009

Pulmonary vein isolation of symptomatic refractory paroxysmal and persistent atrial fibrillation

Therapeutic mild hypothermia improves outcome after out-of-hospital cardiac arrest

Cardiopulmonary exercise testing in congenital heart disease: (contra)indications and interpretation

Cardiac magnetic resonance: a safe procedure?

A rare complication of a pneumococcal pneumonia

Traumatic subdural haematoma with electrocardiographic abnormalities simulating myocardial infarction