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Transesophageal echocardiography in patients with cryptogenic cerebral ischemia.

Knebel F, Masuhr F, von Hausen W, Walde T, Dreger H, Raab V, Yuerek M, Baumann G, Borges AC - Cardiovasc Ultrasound (2009)

Bottom Line: Patients with cryptogenic cerebral ischemia (ischemic stroke, IS, and transient ischemic attack, TIA) were included.In 52.6% of all patients, TEE examination revealed relevant findings.Younger patients had a higher prevalence of PFO, whereas older patients had more frequently atherosclerotic findings.

View Article: PubMed Central - HTML - PubMed

Affiliation: Charité Universitatsmedizin Berlin, Campus Mitte, Medizinische Klinik und Poliklinik mit Schwerpunkt Kardiologie und Angiologie, Berlin, Germany. fabian.knebel@charite.de

ABSTRACT

Background: In about one third of all patients with cerebral ischemia, no definite cause can be identified (cryptogenic stroke). In many patients with initially suspected cryptogenic stroke, however, a cardiogenic etiology can eventually be determined. Hence, the aim of this study was to describe the prevalence of abnormal echocardiographic findings in a large number of these patients.

Method: Patients with cryptogenic cerebral ischemia (ischemic stroke, IS, and transient ischemic attack, TIA) were included. The initial work-up included a neurological examination, EEG, cCT, cMRT, 12-lead ECG, Holter-ECG, Doppler ultrasound of the extracranial arteries, and transthoracic echocardiography. A multiplane transeophageal echocardiography (TEE, including i.v. contrast medium application [Echovist], Valsalva maneuver) was performed in all patients

Results: 702 consecutive patients (380 male, 383 IS, 319 TIA, age 18-90 years) were included. In 52.6% of all patients, TEE examination revealed relevant findings. Overall, the most common findings in all patients were: patent foramen ovale (21.7%), previously undiagnosed valvular disease (15.8%), aortic plaques, aortic valve sclerosis, atrial septal aneurysms, regional myocardial dyskinesia, dilated left atrium and atrial septal defects. Older patients (> 55 years, n = 291) and patients with IS had more relevant echocardiographic findings than younger patients or patients with TIA, respectively (p = 0.002, p = 0.003). The prevalence rates of PFO or ASD were higher in younger patients (PFO: 26.8% vs. 18.0%, p = 0.005, ASD: 9.6% vs. 4.9%, p = 0.014).

Conclusion: A TEE examination in cryptogenic stroke reveals contributing cardiogenic factors in about half of all patients. Younger patients had a higher prevalence of PFO, whereas older patients had more frequently atherosclerotic findings. Therefore, TEE examinations seem indicated in all patients with cryptogenic stroke - irrespective of age - because of specific therapeutic consequences.

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Presence of PFO and ASD in the patients with cryptogenic stroke (n = 291 < 55 years; n = 411 > 55 years).
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Figure 1: Presence of PFO and ASD in the patients with cryptogenic stroke (n = 291 < 55 years; n = 411 > 55 years).

Mentions: In the older patients (> 55 years, n = 291, according to [2,10]) pathological echocardiographic findings were more frequent (p = 0.0023) than in the younger patients. The prevalence of a PFO was higher in the younger patients (< 55 years: n = 78; 26.8%, > 55 years: n = 75; 18.0%, Pearson's Chi square p = 0.005). The frequency of a ASD was lower in the older patients (< 55 years: n = 28; 9.6%, > 55 years: n = 20; 4.9%, Pearson's Chi square p = 0.014); see Figure 1, for examples see Figure 2, Figure 3 and Figure 4 and Additional file 1, Additional file 2 and Additional file 3


Transesophageal echocardiography in patients with cryptogenic cerebral ischemia.

Knebel F, Masuhr F, von Hausen W, Walde T, Dreger H, Raab V, Yuerek M, Baumann G, Borges AC - Cardiovasc Ultrasound (2009)

Presence of PFO and ASD in the patients with cryptogenic stroke (n = 291 < 55 years; n = 411 > 55 years).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2667401&req=5

Figure 1: Presence of PFO and ASD in the patients with cryptogenic stroke (n = 291 < 55 years; n = 411 > 55 years).
Mentions: In the older patients (> 55 years, n = 291, according to [2,10]) pathological echocardiographic findings were more frequent (p = 0.0023) than in the younger patients. The prevalence of a PFO was higher in the younger patients (< 55 years: n = 78; 26.8%, > 55 years: n = 75; 18.0%, Pearson's Chi square p = 0.005). The frequency of a ASD was lower in the older patients (< 55 years: n = 28; 9.6%, > 55 years: n = 20; 4.9%, Pearson's Chi square p = 0.014); see Figure 1, for examples see Figure 2, Figure 3 and Figure 4 and Additional file 1, Additional file 2 and Additional file 3

Bottom Line: Patients with cryptogenic cerebral ischemia (ischemic stroke, IS, and transient ischemic attack, TIA) were included.In 52.6% of all patients, TEE examination revealed relevant findings.Younger patients had a higher prevalence of PFO, whereas older patients had more frequently atherosclerotic findings.

View Article: PubMed Central - HTML - PubMed

Affiliation: Charité Universitatsmedizin Berlin, Campus Mitte, Medizinische Klinik und Poliklinik mit Schwerpunkt Kardiologie und Angiologie, Berlin, Germany. fabian.knebel@charite.de

ABSTRACT

Background: In about one third of all patients with cerebral ischemia, no definite cause can be identified (cryptogenic stroke). In many patients with initially suspected cryptogenic stroke, however, a cardiogenic etiology can eventually be determined. Hence, the aim of this study was to describe the prevalence of abnormal echocardiographic findings in a large number of these patients.

Method: Patients with cryptogenic cerebral ischemia (ischemic stroke, IS, and transient ischemic attack, TIA) were included. The initial work-up included a neurological examination, EEG, cCT, cMRT, 12-lead ECG, Holter-ECG, Doppler ultrasound of the extracranial arteries, and transthoracic echocardiography. A multiplane transeophageal echocardiography (TEE, including i.v. contrast medium application [Echovist], Valsalva maneuver) was performed in all patients

Results: 702 consecutive patients (380 male, 383 IS, 319 TIA, age 18-90 years) were included. In 52.6% of all patients, TEE examination revealed relevant findings. Overall, the most common findings in all patients were: patent foramen ovale (21.7%), previously undiagnosed valvular disease (15.8%), aortic plaques, aortic valve sclerosis, atrial septal aneurysms, regional myocardial dyskinesia, dilated left atrium and atrial septal defects. Older patients (> 55 years, n = 291) and patients with IS had more relevant echocardiographic findings than younger patients or patients with TIA, respectively (p = 0.002, p = 0.003). The prevalence rates of PFO or ASD were higher in younger patients (PFO: 26.8% vs. 18.0%, p = 0.005, ASD: 9.6% vs. 4.9%, p = 0.014).

Conclusion: A TEE examination in cryptogenic stroke reveals contributing cardiogenic factors in about half of all patients. Younger patients had a higher prevalence of PFO, whereas older patients had more frequently atherosclerotic findings. Therefore, TEE examinations seem indicated in all patients with cryptogenic stroke - irrespective of age - because of specific therapeutic consequences.

Show MeSH
Related in: MedlinePlus