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The Effect of Transoesophageal Echocardiography on Treatment Change in a High-Volume Stroke Unit

Background and purpose—current guidelines recommend the use of transesophageal echocardiography (TEE) in relation to cardio-embolic sources of stroke. Methods—by using an hospital-based cohort, we retrospectively analyzed consecutive patients with acute ischemic stroke (AIS), acute hemorrhagic strok...

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Autores principales: Siegel, Camille, Marchandot, Benjamin, Matsushita, Kensuke, Trimaille, Antonin, Mirea, Corina, Peillex, Marilou, Sauer, François, How-Choong, Cecile, Zeyons, Floriane, Rouyer, Olivier, Trinh, Annie, Petit-Eisenmann, Helene, Jesel, Laurence, Ohlmann, Patrick, Wolff, Valérie, Morel, Olivier
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7922802/
https://www.ncbi.nlm.nih.gov/pubmed/33671360
http://dx.doi.org/10.3390/jcm10040805
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author Siegel, Camille
Marchandot, Benjamin
Matsushita, Kensuke
Trimaille, Antonin
Mirea, Corina
Peillex, Marilou
Sauer, François
How-Choong, Cecile
Zeyons, Floriane
Rouyer, Olivier
Trinh, Annie
Petit-Eisenmann, Helene
Jesel, Laurence
Ohlmann, Patrick
Wolff, Valérie
Morel, Olivier
author_facet Siegel, Camille
Marchandot, Benjamin
Matsushita, Kensuke
Trimaille, Antonin
Mirea, Corina
Peillex, Marilou
Sauer, François
How-Choong, Cecile
Zeyons, Floriane
Rouyer, Olivier
Trinh, Annie
Petit-Eisenmann, Helene
Jesel, Laurence
Ohlmann, Patrick
Wolff, Valérie
Morel, Olivier
author_sort Siegel, Camille
collection PubMed
description Background and purpose—current guidelines recommend the use of transesophageal echocardiography (TEE) in relation to cardio-embolic sources of stroke. Methods—by using an hospital-based cohort, we retrospectively analyzed consecutive patients with acute ischemic stroke (AIS), acute hemorrhagic stroke (AHS) and transient ischemic attack (TIA) who were admitted in Strasbourg Stroke Center, France between November 2017 to December 2018. TEE reports were screened for detection of potential cardiac sources of embolism and the subsequent change in medical management. We performed univariate and multivariate analyses to identify predictors of relevant TEE findings. Results-out of the 990 patients admitted with confirmed stroke, 432 patients (42.6%) underwent TEE. Patients with TEE were younger (62.8 ± 14.8 vs. 73.8, p < 0.001), presented less comorbidities and lower stroke severity assessed by lower NIHSS (2 IQR (0–4) vs. 3 IQR (0–10), p < 0.01) and Modified Rankin Scale (1 IQR (0–1) vs. 1 (0–3), p < 0.01). A total of 227 examinations (52.5%) demonstrated abnormal findings considered as potential cardiac sources of embolism and 31 examinations (7.1%) were followed by subsequent change in medical management. Age (HR: 0.948, 95% CI 0.923 to 0.974; p < 0.001), previous AIS (HR: 3.542, 95% CI 1.290 to 9.722; p = 0.01), previous TIA (HR: 7.830, CI 95% 2214 to 27,689; p = 0.001) and superficial middle cerebral artery territory infarction (HR: 2.774, CI 95% 1.168–6.589; p = 0.021) were strong independent predictors with change in medical management following TEE. Conclusions—additional TEE changed the medical course of stroke patients in 7.1% in a French high-volume stroke unit.
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spelling pubmed-79228022021-03-03 The Effect of Transoesophageal Echocardiography on Treatment Change in a High-Volume Stroke Unit Siegel, Camille Marchandot, Benjamin Matsushita, Kensuke Trimaille, Antonin Mirea, Corina Peillex, Marilou Sauer, François How-Choong, Cecile Zeyons, Floriane Rouyer, Olivier Trinh, Annie Petit-Eisenmann, Helene Jesel, Laurence Ohlmann, Patrick Wolff, Valérie Morel, Olivier J Clin Med Article Background and purpose—current guidelines recommend the use of transesophageal echocardiography (TEE) in relation to cardio-embolic sources of stroke. Methods—by using an hospital-based cohort, we retrospectively analyzed consecutive patients with acute ischemic stroke (AIS), acute hemorrhagic stroke (AHS) and transient ischemic attack (TIA) who were admitted in Strasbourg Stroke Center, France between November 2017 to December 2018. TEE reports were screened for detection of potential cardiac sources of embolism and the subsequent change in medical management. We performed univariate and multivariate analyses to identify predictors of relevant TEE findings. Results-out of the 990 patients admitted with confirmed stroke, 432 patients (42.6%) underwent TEE. Patients with TEE were younger (62.8 ± 14.8 vs. 73.8, p < 0.001), presented less comorbidities and lower stroke severity assessed by lower NIHSS (2 IQR (0–4) vs. 3 IQR (0–10), p < 0.01) and Modified Rankin Scale (1 IQR (0–1) vs. 1 (0–3), p < 0.01). A total of 227 examinations (52.5%) demonstrated abnormal findings considered as potential cardiac sources of embolism and 31 examinations (7.1%) were followed by subsequent change in medical management. Age (HR: 0.948, 95% CI 0.923 to 0.974; p < 0.001), previous AIS (HR: 3.542, 95% CI 1.290 to 9.722; p = 0.01), previous TIA (HR: 7.830, CI 95% 2214 to 27,689; p = 0.001) and superficial middle cerebral artery territory infarction (HR: 2.774, CI 95% 1.168–6.589; p = 0.021) were strong independent predictors with change in medical management following TEE. Conclusions—additional TEE changed the medical course of stroke patients in 7.1% in a French high-volume stroke unit. MDPI 2021-02-17 /pmc/articles/PMC7922802/ /pubmed/33671360 http://dx.doi.org/10.3390/jcm10040805 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Siegel, Camille
Marchandot, Benjamin
Matsushita, Kensuke
Trimaille, Antonin
Mirea, Corina
Peillex, Marilou
Sauer, François
How-Choong, Cecile
Zeyons, Floriane
Rouyer, Olivier
Trinh, Annie
Petit-Eisenmann, Helene
Jesel, Laurence
Ohlmann, Patrick
Wolff, Valérie
Morel, Olivier
The Effect of Transoesophageal Echocardiography on Treatment Change in a High-Volume Stroke Unit
title The Effect of Transoesophageal Echocardiography on Treatment Change in a High-Volume Stroke Unit
title_full The Effect of Transoesophageal Echocardiography on Treatment Change in a High-Volume Stroke Unit
title_fullStr The Effect of Transoesophageal Echocardiography on Treatment Change in a High-Volume Stroke Unit
title_full_unstemmed The Effect of Transoesophageal Echocardiography on Treatment Change in a High-Volume Stroke Unit
title_short The Effect of Transoesophageal Echocardiography on Treatment Change in a High-Volume Stroke Unit
title_sort effect of transoesophageal echocardiography on treatment change in a high-volume stroke unit
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7922802/
https://www.ncbi.nlm.nih.gov/pubmed/33671360
http://dx.doi.org/10.3390/jcm10040805
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