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Siegel C, Marchandot B, Matsushita K, Trimaille A, Mirea C, Peillex M, Sauer F, How-Choong C, Zeyons F, Rouyer O, Trinh A, Petit-Eisenmann H, Jesel L, Ohlmann P, Wolff V, Morel O. The Effect of Transoesophageal Echocardiography on Treatment Change in a High-Volume Stroke Unit. J Clin Med 2021; 10:jcm10040805. [PMID: 33671360 PMCID: PMC7922802 DOI: 10.3390/jcm10040805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/04/2021] [Accepted: 02/15/2021] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Camille Siegel
- Division of Cardiovascular Medicine, Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; (C.S.); (B.M.); (K.M.); (A.T.); (C.M.); (M.P.); (F.S.); (C.H.-C.); (F.Z.); (A.T.); (H.P.-E.); (L.J.); (P.O.)
| | - Benjamin Marchandot
- Division of Cardiovascular Medicine, Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; (C.S.); (B.M.); (K.M.); (A.T.); (C.M.); (M.P.); (F.S.); (C.H.-C.); (F.Z.); (A.T.); (H.P.-E.); (L.J.); (P.O.)
| | - Kensuke Matsushita
- Division of Cardiovascular Medicine, Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; (C.S.); (B.M.); (K.M.); (A.T.); (C.M.); (M.P.); (F.S.); (C.H.-C.); (F.Z.); (A.T.); (H.P.-E.); (L.J.); (P.O.)
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, 67000 Strasbourg, France
| | - Antonin Trimaille
- Division of Cardiovascular Medicine, Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; (C.S.); (B.M.); (K.M.); (A.T.); (C.M.); (M.P.); (F.S.); (C.H.-C.); (F.Z.); (A.T.); (H.P.-E.); (L.J.); (P.O.)
| | - Corina Mirea
- Division of Cardiovascular Medicine, Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; (C.S.); (B.M.); (K.M.); (A.T.); (C.M.); (M.P.); (F.S.); (C.H.-C.); (F.Z.); (A.T.); (H.P.-E.); (L.J.); (P.O.)
| | - Marilou Peillex
- Division of Cardiovascular Medicine, Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; (C.S.); (B.M.); (K.M.); (A.T.); (C.M.); (M.P.); (F.S.); (C.H.-C.); (F.Z.); (A.T.); (H.P.-E.); (L.J.); (P.O.)
| | - François Sauer
- Division of Cardiovascular Medicine, Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; (C.S.); (B.M.); (K.M.); (A.T.); (C.M.); (M.P.); (F.S.); (C.H.-C.); (F.Z.); (A.T.); (H.P.-E.); (L.J.); (P.O.)
| | - Cecile How-Choong
- Division of Cardiovascular Medicine, Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; (C.S.); (B.M.); (K.M.); (A.T.); (C.M.); (M.P.); (F.S.); (C.H.-C.); (F.Z.); (A.T.); (H.P.-E.); (L.J.); (P.O.)
| | - Floriane Zeyons
- Division of Cardiovascular Medicine, Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; (C.S.); (B.M.); (K.M.); (A.T.); (C.M.); (M.P.); (F.S.); (C.H.-C.); (F.Z.); (A.T.); (H.P.-E.); (L.J.); (P.O.)
| | - Olivier Rouyer
- Neurology Department, Hautepierre Hospital, Strasbourg University Hospital, 67000 Strasbourg, France; (O.R.); (V.W.)
| | - Annie Trinh
- Division of Cardiovascular Medicine, Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; (C.S.); (B.M.); (K.M.); (A.T.); (C.M.); (M.P.); (F.S.); (C.H.-C.); (F.Z.); (A.T.); (H.P.-E.); (L.J.); (P.O.)
| | - Helene Petit-Eisenmann
- Division of Cardiovascular Medicine, Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; (C.S.); (B.M.); (K.M.); (A.T.); (C.M.); (M.P.); (F.S.); (C.H.-C.); (F.Z.); (A.T.); (H.P.-E.); (L.J.); (P.O.)
| | - Laurence Jesel
- Division of Cardiovascular Medicine, Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; (C.S.); (B.M.); (K.M.); (A.T.); (C.M.); (M.P.); (F.S.); (C.H.-C.); (F.Z.); (A.T.); (H.P.-E.); (L.J.); (P.O.)
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, 67000 Strasbourg, France
| | - Patrick Ohlmann
- Division of Cardiovascular Medicine, Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; (C.S.); (B.M.); (K.M.); (A.T.); (C.M.); (M.P.); (F.S.); (C.H.-C.); (F.Z.); (A.T.); (H.P.-E.); (L.J.); (P.O.)
| | - Valérie Wolff
- Neurology Department, Hautepierre Hospital, Strasbourg University Hospital, 67000 Strasbourg, France; (O.R.); (V.W.)
| | - Olivier Morel
- Division of Cardiovascular Medicine, Hôpital Civil, Strasbourg University Hospital, 67000 Strasbourg, France; (C.S.); (B.M.); (K.M.); (A.T.); (C.M.); (M.P.); (F.S.); (C.H.-C.); (F.Z.); (A.T.); (H.P.-E.); (L.J.); (P.O.)
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, 67000 Strasbourg, France
- Correspondence: ; Tel.: +33-3695-50949; Fax: +33-3695-51736
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Specktor P, Yalonetsky S, Agmon Y, Sprecher E, Ali FH, Telman G. The effect of TEE on treatment change in patients with acute ischemic stroke. PLoS One 2020; 15:e0243142. [PMID: 33270736 PMCID: PMC7714247 DOI: 10.1371/journal.pone.0243142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/17/2020] [Indexed: 11/19/2022] Open
Abstract
Background and purpose Ischemic stroke is a widespread disease carrying high morbidity and mortality. Transesophageal echocardiography (TEE) is considered an important tool in the work-up of patients with acute ischemic stroke (AIS) and transient ischemic attack (TIA) patients; its utility is limited by a semi-invasive nature. The purpose of this study was to evaluate the probability of treatment change due to TEE findings (yield) in the work-up of AIS and TIA patients. Methods Retrospective data on patients with AIS or TIA who underwent TEE examination between 2000–2013 were collected from the institutional registry. Results The average age of 1284 patients who were included in the study was 57±10.4, 66% of patients were male. The most frequent TEE findings included aortic plaques in 54% and patent foramen ovale (PFO) in 15%. TEE findings led to treatment change in 135 (10.5%) patients; anticoagulant treatment was initiated in 110 of them (81%). Most common etiology for switch to anticoagulation was aortic plaques (71 patients); PFO was second most common reason (26 patients). Significant TEE findings (thrombus, endocarditis, tumor) were found in 1.9% of patients, they were more common in young patients (<55; 56% of the patients). Conclusions The beginning of anticoagulation treatment in patients with thick and complicated plaques was found frequently in our study. Significant TEE findings, were infrequent, constituted an absolute indication for treatment change and were more common in younger patients.
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Affiliation(s)
- Polina Specktor
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
- Department of Neurology, Carmel Hospital, Haifa, Israel
| | | | - Yoram Agmon
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Elliot Sprecher
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Faten Haj Ali
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Gregory Telman
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
- Technion, Israel Institute of Technology, Haifa, Israel
- * E-mail:
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