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[Potential embolism sources in transesophageal echocardiography--prognostic value in patients with cerebral ischemia]
H Völler1, R Dissmann, K Schröder
1Klinik am See, Rehabilitationszentrum für Herz und Kreislauf, Rüdersdorf.
Insights
Potential sources of embolism like atrial septal aneurysm and patent foramen ovale do not increase recurrence after a first cerebral ischemic event in healthy individuals. However, in patients with cardiovascular disease, these sources are linked to a higher risk of recurrent events.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Cerebral ischemic events (CIE) pose significant health risks.
- Identifying sources of embolism is crucial for predicting recurrence.
- Potential sources include atrial septal aneurysm (ASA), patent foramen ovale (PFO), mitral valve prolapse, and aortic debris.
Purpose of the Study:
- To investigate the influence of potential embolism sources on recurrence after a first CIE.
- To assess the combined impact of embolism sources and cardiovascular risk factors on CIE recurrence.
Main Methods:
- Transesophageal echocardiography (TEE) was used to examine 214 patients post-CIE.
- Patients were followed for 12 months to track recurrent events.
- Analysis stratified patients based on the presence of embolism sources and cardiovascular/atherosclerotic risk factors.
Main Results:
- Recurrence occurred in 6.5% of patients.
- ASA, PFO, and aortic debris showed a 2-3 fold higher incidence of recurrence when combined with cardiovascular diseases and risk factors.
- Embolism sources alone did not significantly impact recurrence rates (7.2% vs 5.8%).
- Patients with cardiovascular diseases and embolism sources had a significantly higher recurrence rate (9.8% vs 0%, p < 0.01).
Conclusions:
- Potential embolism sources do not increase recurrence risk in cardiac-healthy individuals after a first CIE.
- In patients with cardiovascular diseases, identified embolism sources are associated with a significantly higher risk of recurrent cerebral ischemic events.
- Transesophageal echocardiography is recommended for imaging these sources in patients with cardiovascular disease.
Abstract:
To determine whether potential sources of embolism such as atrial septal aneurysm (ASA), patent foramen ovale (PFO), mitral valve prolapse and atherosclerotic aortic debris can influence the outcome of patients after first cerebral ischemic event (CIE), 214 patients (124 stroke, 21 RIND, 69 TIA) were examined by transesophageal echocardiography (TEE) up to 3 weeks after CIE and followed up for 12 months. For risk estimation, the patients were subdivided into group I = without and group II = with potential sources of embolism. We additionally took into account cardiovascular diseases and atherosclerotic risk factors (group la + IIa without, Ib + IIb with). Recurrence occurred in 14 out of 214 patients (6.5%). Univariate analysis demonstrated that the presence of ASA, PFO and aortic debris as well as cardiovascular diseases and atherosclerotic risk factors was associated with a twofold to threefold higher incidence of recurrent events. While potential sources of embolism alone had no influence on the recurrence rate (group I:8/111 = 7.2% versus group II: 6/103 = 5.8%, n.s.), this was significantly different in relation to cardiovascular diseases and atherosclerotic risk factors (groups Ia + IIa: 0/66 = 0%, groups Ib + IIb: 14/148 = 9.8%, p < 0.01). Our results show that potential sources of embolism do not appear to influence the recurrence rate in cardiac healthy subjects. In patients with cardiovascular diseases, however, potential sources of embolism are associated with a higher risk of recurrence, and should therefore be imaged by TEE.