open access

Vol 53, No 2 (2019)
Research Paper
Submitted: 2019-01-04
Accepted: 2019-04-09
Published online: 2019-04-25
Get Citation

Transthoracic echocardiography in the assessment of cardiogenic causes of ischaemic stroke

Wojciech Król1, Anna Żarek2, Aleksandra Wilk2, Wioletta Guzik2, Marlena Ziemska2, Marcin Konopka1, Magdalena Franczuk-Gwiazda3, Marek Kuch4, Wojciech Braksator1
·
Pubmed: 31020990
·
Neurol Neurochir Pol 2019;53(2):156-161.
Affiliations
  1. Medical University of Warsaw, 2nd Medical Faculty, Department of Sports Cardiology and Noninvasive Cardiovascular Imaging, Warsaw, Poland
  2. Medical University of Warsaw, Warsaw, Poland
  3. Masovian, Specialists Health Centre, 9th Department (Neurology), Pruszkow, Poland
  4. Medical University of Warsaw, Department of Cardiology, Hypertension and Internal Diseases, Warsaw, Poland

open access

Vol 53, No 2 (2019)
Research papers
Submitted: 2019-01-04
Accepted: 2019-04-09
Published online: 2019-04-25

Abstract

Introduction. One of the leading causes of death in Poland is stroke. Cardiogenic stroke is known to be one of the most important reasons for acute ischaemic stroke (AIS), comprising 25–30% of all AISs.

Aim of study. Assessment of the prevalence of different risk factors of cardiogenic causes of AIS using transthoracic echocardiography (TTE).

Material and methods. Transthoracic echocardiograms performed in patients with AIS admitted to a single neurological ward between October 2013 and September 2017 were analysed. Patients were assigned, based on the results of their TTE and their previous medical history of atrial fibrillation (AF), to one of three groups depending on the level of the risk of occurrence of cardiogenic causes of AIS.

Ethical permission. According to Dz.U.2001, no. 126, 1381 no ethical permission was needed.

Results. 663 patients with AIS were included in the study. Patients with high risk of cardiogenic cause of AIS: 26.7% (N = 177 patients [p]). Of these, 64.4% (114 p) were diagnosed with AF. 31.6% (56 p) with sinus rhythm during hospitalisation had a history of paroxysmal AF (PAF). In 11.9% (21 p) of the patients qualified to the high risk group, factors other than AF were found. Patients with moderate risk of cardiogenic cause of AIS: 10.1% (67 p). Patients with low risk of cardiogenic cause of AIS: 25.9% (172 p). Echocardiographic results led to a change in therapy in 1.21% of cases.

Conclusions. 1. Transthoracic echocardiography performed routinely in all AIS patients affects the treatment in a very low percentage of cases. 2. The group that could benefit the most from TTE examination includes people without established indications for chronic anticoagulant therapy, in particular patients after myocardial infarction and people with additional clinical symptoms. 3. In patients with AIS, the diagnostic sensitivity of TTE in the detection of PFO is low. Young people with a cryptogenic ischaemic stroke should undergo a transoesophageal assessment.

Abstract

Introduction. One of the leading causes of death in Poland is stroke. Cardiogenic stroke is known to be one of the most important reasons for acute ischaemic stroke (AIS), comprising 25–30% of all AISs.

Aim of study. Assessment of the prevalence of different risk factors of cardiogenic causes of AIS using transthoracic echocardiography (TTE).

Material and methods. Transthoracic echocardiograms performed in patients with AIS admitted to a single neurological ward between October 2013 and September 2017 were analysed. Patients were assigned, based on the results of their TTE and their previous medical history of atrial fibrillation (AF), to one of three groups depending on the level of the risk of occurrence of cardiogenic causes of AIS.

Ethical permission. According to Dz.U.2001, no. 126, 1381 no ethical permission was needed.

Results. 663 patients with AIS were included in the study. Patients with high risk of cardiogenic cause of AIS: 26.7% (N = 177 patients [p]). Of these, 64.4% (114 p) were diagnosed with AF. 31.6% (56 p) with sinus rhythm during hospitalisation had a history of paroxysmal AF (PAF). In 11.9% (21 p) of the patients qualified to the high risk group, factors other than AF were found. Patients with moderate risk of cardiogenic cause of AIS: 10.1% (67 p). Patients with low risk of cardiogenic cause of AIS: 25.9% (172 p). Echocardiographic results led to a change in therapy in 1.21% of cases.

Conclusions. 1. Transthoracic echocardiography performed routinely in all AIS patients affects the treatment in a very low percentage of cases. 2. The group that could benefit the most from TTE examination includes people without established indications for chronic anticoagulant therapy, in particular patients after myocardial infarction and people with additional clinical symptoms. 3. In patients with AIS, the diagnostic sensitivity of TTE in the detection of PFO is low. Young people with a cryptogenic ischaemic stroke should undergo a transoesophageal assessment.

Get Citation

Keywords

stroke, atrial fibrillation, transthoracic echocardiography, cardiogenic stroke, echocardiography

About this article
Title

Transthoracic echocardiography in the assessment of cardiogenic causes of ischaemic stroke

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 53, No 2 (2019)

Article type

Research Paper

Pages

156-161

Published online

2019-04-25

Page views

1943

Article views/downloads

378

DOI

10.5603/PJNNS.a2019.0016

Pubmed

31020990

Bibliographic record

Neurol Neurochir Pol 2019;53(2):156-161.

Keywords

stroke
atrial fibrillation
transthoracic echocardiography
cardiogenic stroke
echocardiography

Authors

Wojciech Król
Anna Żarek
Aleksandra Wilk
Wioletta Guzik
Marlena Ziemska
Marcin Konopka
Magdalena Franczuk-Gwiazda
Marek Kuch
Wojciech Braksator

References (31)
  1. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015; 385(9963): 117–171.
  2. Celeste F, Muratori M, Mapelli M, et al. The Evolving Role and Use of Echocardiography in the Evaluation of Cardiac Source of Embolism. J Cardiovasc Echogr. 2017; 27(2): 33–44.
  3. Staszewski J, Pruszczyk P. Diagnostyka udaru kardiogennego. Neurologia po dyplomie. 2015; 05: 34–43.
  4. Nakanishi K, Homma S. Role of echocardiography in patients with stroke. J Cardiol. 2016; 68(2): 91–99.
  5. Olsen TS, Langhorne P, Diener HC, et al. European Stroke Initiative Executive Committee, EUSI Writing Committee. European Stroke Initiative Recommendations for Stroke Management-update 2003. Cerebrovasc Dis. 2003; 16(4): 311–337.
  6. Kirchhof P, Benussi S, Kotecha D, et al. ESC Scientific Document Group. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016; 37(38): 2893–2962.
  7. Saxena R, Lewis S, Berge E, et al. Risk of early death and recurrent stroke and effect of heparin in 3169 patients with acute ischemic stroke and atrial fibrillation in the International Stroke Trial. Stroke. 2001; 32(10): 2333–2337.
  8. Kou S, Caballero L, Dulgheru R, et al. Echocardiographic reference ranges for normal cardiac chamber size: results from the NORRE study. Eur Heart J Cardiovasc Imaging. 2014; 15(6): 680–690.
  9. Camm AJ, Kirchhof P, Lip GYH, et al. U. Schotten U, Wytyczne dotyczące postępowania u chorych z migotaniem przedsionków. Kardiologia Polska. 2010; 68(supl. VII).
  10. Weintraub RG, Semsarian C, Macdonald P. Dilated cardiomyopathy. Lancet. 2017; 390(10092): 400–414.
  11. Saric M, Armour AC, Arnaout MS, et al. Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism. J Am Soc Echocardiogr. 2016; 29(1): 1–42.
  12. Ay H, Benner T, Arsava EM, et al. A computerized algorithm for etiologic classification of ischemic stroke: the Causative Classification of Stroke System. Stroke. 2007; 38(11): 2979–2984.
  13. Pepi M, Evangelista A, Nihoyannopoulos P, et al. European Association of Echocardiography. Recommendations for echocardiography use in the diagnosis and management of cardiac sources of embolism: European Association of Echocardiography (EAE) (a registered branch of the ESC). Eur J Echocardiogr. 2010; 11(6): 461–476.
  14. Sacco R, Adams R, Albers G, et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack. Stroke. 2006; 37(2): 577–617.
  15. Asinger RW, Dyken ML, Fisher M, et al. Cardiogenic brain embolism: The second report of the cerebral embolism task force. Archives of Neurology. 1989; 46(7): 727–743.
  16. Dyken ML, Fisher M, Harrison MJG, et al. Cardiogenic brain embolism. Archives of Neurology. 1986; 43(1): 71–84.
  17. Elliott P, Anastasakis A, Borger M, et al. Wytyczne ESC dotyczące rozpoznawania i postępowania w kardiomiopatii przerostowej w 2014 roku. Kardiologia Polska. 2014; 72(11): 1054–1126.
  18. Zhang L, Harrison JK, Goldstein LB. Echocardiography for the detection of cardiac sources of embolism in patients with stroke or transient ischemic attack. J Stroke Cerebrovasc Dis. 2012; 21(7): 577–582.
  19. Herm J, Konieczny M, Jungehulsing GJ, et al. Should transesophageal echocardiography be performed in acute stroke patients with atrial fibrillation? J Clin Neurosci. 2013; 20(4): 554–559.
  20. Casaclang-Verzosa G, Gersh BJ, Tsang TSM. Structural and functional remodeling of the left atrium: clinical and therapeutic implications for atrial fibrillation. J Am Coll Cardiol. 2008; 51(1): 1–11.
  21. Flaker GC, Fletcher KA, Rothbart RM, et al. Clinical and echocardiographic features of intermittent atrial fibrillation that predict recurrent atrial fibrillation. Stroke Prevention in Atrial Fibrillation (SPAF) Investigators. Am J Cardiol. 1995; 76(5): 355–358.
  22. Luo Y, Zhu Y, Guan X, et al. Assessment of mitral annulus and mitral leaflet in nonvalvular atrial fibrillation patients with various degrees of mitral regurgitation: Real time 3D transesophageal echocardiography. Echocardiography. 2018; 35(4): 481–486.
  23. Olsson KM, Nickel NP, Tongers J, et al. Atrial flutter and fibrillation in patients with pulmonary hypertension. Int J Cardiol. 2013; 167(5): 2300–2305.
  24. Papadopoulos CH, Oikonomidis D, Lazaris E, et al. Echocardiography and cardiac arrhythmias. Hellenic J Cardiol. 2018; 59(3): 140–149.
  25. Park KM, Im SIl, Kim EK, et al. Atrial Fibrillation in Hypertrophic Cardiomyopathy: Is the Extent of Septal Hypertrophy Important? PLoS One. 2016; 11(6): e0156410.
  26. Ruiz-Cano MJ, Gonzalez-Mansilla A, Escribano P, et al. Clinical implications of supraventricular arrhythmias in patients with severe pulmonary arterial hypertension. Int J Cardiol. 2011; 146(1): 105–106.
  27. Tongers J, Schwerdtfeger B, Klein G, et al. Incidence and clinical relevance of supraventricular tachyarrhythmias in pulmonary hypertension. Am Heart J. 2007; 153(1): 127–132.
  28. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28(1): 1–39.e14.
  29. Hutyra M, Pavlů L, Šaňák D, et al. The role of echocardiography in patients after ischemic stroke. Cor et Vasa. 2016; 58(2): e261–e272.
  30. Hagen PT, Scholz DG, Edwards WD. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc. 1984; 59(1): 17–20.
  31. Johansson MC, Eriksson P, Dellborg M. The significance of patent foramen ovale: a current review of associated conditions and treatment. Int J Cardiol. 2009; 134(1): 17–24.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl