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Cardiac sources of embolism should be routinely screened in ischemic colitis
Isabelle Hourmand-Ollivier1, Mickael Bouin, Eric Saloux
1Services d'Hépatogastroentérologie et de Nutrition, Centre Hospitalier Universitaire Côte de Nacre, Caen, France.
Insights
Cardiac embolism is a significant risk factor for ischemic colitis. Routine cardiac evaluations including electrocardiogram, Holter monitoring, and echocardiography are recommended for patients diagnosed with this condition.
Area of Science:
- Cardiology
- Gastroenterology
- Internal Medicine
Background:
- Potential cardiac sources of embolism are implicated in the pathogenesis of ischemic colitis.
- Segmental, nongangrenous ischemic colitis requires thorough investigation for underlying causes.
Purpose of the Study:
- To evaluate the role of cardiac embolism in segmental, nongangrenous ischemic colitis.
- To determine the utility of routine cardiac assessments in managing this condition.
Main Methods:
- A case-control study involving 60 patients with ischemic colitis and 60 matched controls.
- Cardiac embolism screening utilized electrocardiogram, 24-hour Holter monitoring, and transthoracic echocardiography.
Main Results:
- A cardiac source of embolism was identified in 43% of ischemic colitis cases versus 23% of controls (p=0.02).
- Proven cardiac sources were found in 35% of cases compared to 13% of controls (p<0.01).
- Electrocardiogram alone had a high misdiagnosis rate; combined testing improved detection, with 12 new cases identified.
Conclusions:
- Cardiac embolism is significantly more prevalent in patients with segmental, nongangrenous ischemic colitis.
- Routine cardiac evaluation (ECG, Holter, echocardiography) is crucial for these patients.
- Consideration of anticoagulant therapy is advised for patients with identified cardiac sources.
Objective:
Potential cardiac sources of embolism may promote ischemic colitis. The aim of this study was to evaluate their role in segmental, nongangrenous ischemic colitis and to determine the usefulness of routine cardiac evaluation in patients with this disease.
Methods:
Sixty case and 60 control patients matched for age and gender were included and questioned regarding treatment and prior cardiovascular history or risk factors. Potential cardiac sources of embolism, classified as "proven" or " still debated," were screened using an electrocardiogram, rhythmic Holter monitoring over 24 h, and transthoracic echocardiography.
Results:
Sex ratio (male:female) was 1:2, and mean age was 70 +/- 14 yr. Case and control patients had similar drug use, prior cardiovascular history, and risk factors. A potential cardiac source of embolism was found in 26/60 case (43%), compared with 14/60 control patients (23%) (p = 0.02; OR = 2.5, 95% CI = 1.2-5.5). Excluding the "still debated," 21/60 case (35%), compared with 8/60 control patients (13%), had a "proven" cardiac source of embolism (p < 0.01; OR = 3.5, 95% CI = 1.4-8.4). Electrocardiogram alone misdiagnosed 72% of the "proven" cardiac sources of embolism, whereas the combination electrocardiogram plus Holter monitoring detected 71%, and electrocardiogram plus echocardiography 62%. Twelve of 21 case patients with at least one proven cardiac source of embolism, were previously unknown. Anticoagulant therapy was required in 32% of case patients and antiarrhythmic therapy in 25% of cases.
Conclusions:
Potential cardiac sources of embolism were more common in patients with segmental, nongangrenous ischemic colitis than in control patients. Therefore, these patients should undergo a routine electrocardiogram, rhythmic Holter monitoring, and transthoracic echocardiography. Anticoagulant therapy should also be considered for this patient population.