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Influence of echocardiography on management of patients with systemic emboli
Insights
Two dimensional echocardiography may identify cardiac sources of systemic embolism in patients with cardiovascular disease, but it does not alter early management. M-mode echocardiography is not useful for evaluating patients with systemic emboli.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Systemic embolism poses a significant clinical challenge.
- Echocardiography is a key imaging modality in cardiovascular diagnostics.
Purpose of the Study:
- To evaluate the impact of echocardiography on the management of patients with suspected systemic embolism.
- To determine the diagnostic utility of M-mode versus two-dimensional echocardiography in identifying cardiac sources of embolism.
Main Methods:
- Retrospective review of medical records and echocardiograms from 191 patients with suspected systemic embolism.
- Classification of patients into groups based on cardiovascular disease and hypertension status.
- Analysis of changes in therapeutic management following echocardiographic examination.
Main Results:
- M-mode echocardiography failed to identify any cardiac source of systemic embolism.
- Two-dimensional echocardiography identified cardiac sources in 13 patients, all with known cardiovascular disease.
- Therapeutic changes occurred in 30.7% of patients with identified cardiac sources versus 33.3% in those without, indicating no significant impact on early management.
Conclusions:
- M-mode echocardiography has no role in the evaluation of patients with systemic emboli.
- Two-dimensional echocardiography can identify cardiac sources in patients with cardiovascular disease but does not significantly alter early management strategies.
Abstract:
To determine the impact of echocardiography in management of patients with systemic embolism, we retrospectively reviewed medical records and echocardiograms of 191 consecutive patients with suspected systemic embolism. One hundred sixteen patients had two dimensional echocardiograms and 75 patients had M-mode echocardiograms only. Patients were divided into three groups: Group 1 had no cardiovascular disease; Group 2 had cardiovascular disease, and Group 3 had hypertension only. Changes in therapy following echocardiogram were defined as initiation or discontinuation of anticoagulants or antiplatelet agents, cardioversion, or surgical intervention. M-mode echocardiogram did not identify any heart as a likely source of systemic embolism. Two dimensional echocardiogram defined 13 hearts as likely sources of emboli. All of these patients had known cardiovascular disease. Four of 13 patients (30.7%) whose hearts were likely sources of emboli had a change in therapy compared with 42 of 126 patients (33.3%) with low probability echocardiograms. We conclude that M-mode echocardiogram has no role in evaluation of patients with systemic emboli. Two dimensional echocardiogram may identify the heart as a source of emboli in patients with cardiovascular disease but does not alter early management.