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[Echocardiographic discoveries in 102 patients with vascular cerebral accidents]
F Ricou1, J Gabathuler, N Aebischer
1Centre de cardiologie, hôpital Cantonal Universitaire de Genève.
Insights
Echocardiography identified high-risk cardiac embolism sources in 14% of patients with vascular ischaemic events, guiding anticoagulant therapy decisions. This cardiac imaging is crucial for preventing recurrent strokes and peripheral artery disease.
Area of Science:
- Cardiology
- Neurology
- Vascular Medicine
Context:
- Vascular ischaemic accidents, including stroke, have diverse causes.
- Management often focuses on secondary prevention, especially when the brain is affected.
- Cardiac sources of embolism are potentially curable, necessitating thorough cardiac evaluation.
Purpose:
- To prospectively analyze cardiovascular examinations and echocardiography in patients with ischaemic events.
- To determine the impact of echocardiography on diagnosis and treatment.
- To assess the influence of specific cardiac diagnoses on the need for anticoagulant therapy.
Summary:
- 102 patients with cerebral or peripheral vascular ischaemic events underwent cardiovascular examinations and echocardiography.
- High-risk embolism sources (e.g., intracardiac thrombi, severe left ventricular dysfunction) were identified in 14% of patients.
- Severe left ventricular dysfunction was the most common high-risk cardiac finding (71% of high-risk cases).
Impact:
- Echocardiography revealed high-risk cardiac embolism sources in 11% of stroke patients and 36% of peripheral vascular accident patients.
- The study identified specific cardiac conditions associated with high and low risks of embolism.
- Anticoagulant treatment was modified in only one case post-echocardiography, suggesting existing management protocols were largely appropriate.
Abstract:
The causes of vascular ischaemic accidents are numerous, and when the brain is involved management is limited to the prevention of similar events. Since cardiac sources of embolism potentially curable, we have prospectively analyzed the results of cardiovascular examinations (including ECG and radiography of the chest) and of echocardiography in 102 patients with cerebral or peripheral vascular ischaemic event in order to determine the impact of echocardiography and the influence of different diagnoses on the need for anticoagulant therapy. Intracardiac thrombi, mitral stenosis, dilated cardiomyopathy, severe left ventricular dysfunction with or without aneurysm and cardiac valve vegetations were regarded as diseases carrying a high risk of embolism, the low risk diseases being mitral valve prolapse, mitral annulus calcification and isolated left atrial dilatation. Atrial fibrillation was treated separately, as it may be associated with several of the diseases listed above. We found 14 diseases with a high risk of embolism (14 p. 100) and 35 diseases with a low risk of embolism (34 p. 100). 10/91 patients with cerebral vascular accident (11 p. 100) and 4/11 patients with peripheral vascular accident presented with a heart disease carrying a high risk of embolism. The most common heart disease with a high risk of embolism (10/14, 71 p. 100) was severe left ventricular dysfunction secondary to a coronary disease or a dilated cardiomyopathy. We did not find more cases of mitral valve prolapse or mitral annulus calcification than in the normal population. 20/29 patients with normal cardiac examination had a normal echocardiogram. The anticoagulant treatment was modified after echocardiography in only one case.(ABSTRACT TRUNCATED AT 250 WORDS)