Cargando…
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...
Autores principales: | , , , , , , , , , , , , , , , |
---|---|
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 |
_version_ | 1783658769746493440 |
---|---|
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. |
format | Online Article Text |
id | pubmed-7922802 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
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 |
work_keys_str_mv | AT siegelcamille theeffectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT marchandotbenjamin theeffectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT matsushitakensuke theeffectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT trimailleantonin theeffectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT mireacorina theeffectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT peillexmarilou theeffectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT sauerfrancois theeffectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT howchoongcecile theeffectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT zeyonsfloriane theeffectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT rouyerolivier theeffectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT trinhannie theeffectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT petiteisenmannhelene theeffectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT jesellaurence theeffectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT ohlmannpatrick theeffectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT wolffvalerie theeffectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT morelolivier theeffectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT siegelcamille effectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT marchandotbenjamin effectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT matsushitakensuke effectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT trimailleantonin effectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT mireacorina effectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT peillexmarilou effectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT sauerfrancois effectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT howchoongcecile effectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT zeyonsfloriane effectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT rouyerolivier effectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT trinhannie effectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT petiteisenmannhelene effectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT jesellaurence effectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT ohlmannpatrick effectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT wolffvalerie effectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit AT morelolivier effectoftransoesophagealechocardiographyontreatmentchangeinahighvolumestrokeunit |