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Acute type A aortic dissection--diagnostic aspects and surgical experience.

https://arctichealth.org/en/permalink/ahliterature54947
Source
Scand J Thorac Cardiovasc Surg. 1994;28(2):61-6
Publication Type
Article
Date
1994
Author
R. Pokela
T. Juvonen
J. Satta
P. Kärkölä
Author Affiliation
Department of Surgery, Oulu University Hospital, Finland.
Source
Scand J Thorac Cardiovasc Surg. 1994;28(2):61-6
Date
1994
Language
English
Publication Type
Article
Keywords
Acute Disease
Adult
Aged
Anastomosis, Surgical - adverse effects
Aneurysm, Dissecting - diagnosis - surgery
Angiography, Digital Subtraction
Aortic Aneurysm - diagnosis - surgery
Aortic Aneurysm, Thoracic - surgery
Blood Vessel Prosthesis
Cardiac Tamponade - ultrasonography
Echocardiography, Transesophageal
Female
Follow-Up Studies
Humans
Male
Middle Aged
Postoperative Complications
Reoperation
Survival Rate
Tomography, X-Ray Computed
Treatment Outcome
Abstract
Acute type A aortic dissection was surgically treated in 33 patients aged 20-65 years, all critically ill on admission to hospital. Transthoracic echocardiography revealed pericardiac tamponade in eight cases of extreme emergency, indicating surgery without need of additional imaging. Transesophageal echocardiography provided a definitive diagnosis in 16 cases, with excellent reliability and no false positive findings. Composite graft replacement with button technique was used in 24 patients and other methods of repair in nine. The perioperative mortality was 12% (4/33) and the late mortality 7% (2/29). The actuarial 5-year survival rate was 73%. No aortic root reoperation was required during follow-up for a mean of 4 years. Transesophageal echocardiography proved to be an accurate tool for speedy diagnosis of acute type A aortic dissection and open composite graft replacement with button technique highly satisfactory treatment, avoiding late aortic root problems.
PubMed ID
7863287 View in PubMed
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Advanced age, low left atrial appendage velocity, and factor V promoter sequence variation as predictors of left atrial thrombosis in patients with nonvalvular atrial fibrillation.

https://arctichealth.org/en/permalink/ahliterature146014
Source
J Thromb Thrombolysis. 2010 Aug;30(2):192-9
Publication Type
Article
Date
Aug-2010
Author
Dmitry A Zateyshchikov
Alexey N Brovkin
Dimitry A Chistiakov
Valery V Nosikov
Author Affiliation
Scientific-Educational Medical Center of the Department of General Management of Russian President, Moscow, Russia.
Source
J Thromb Thrombolysis. 2010 Aug;30(2):192-9
Date
Aug-2010
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Atrial Appendage - physiopathology - ultrasonography
Atrial Fibrillation - complications - physiopathology - ultrasonography
Atrial Function, Left
Chi-Square Distribution
Cross-Sectional Studies
Echocardiography, Transesophageal
Factor V - genetics
Female
Genetic Predisposition to Disease
Humans
Logistic Models
Male
Middle Aged
Odds Ratio
Polymerase Chain Reaction
Polymorphism, Genetic
Polymorphism, Restriction Fragment Length
Promoter Regions, Genetic
Risk assessment
Risk factors
Russia
Stroke Volume
Thrombosis - etiology - genetics - physiopathology
Ventricular Function, Left
Abstract
Atrial fibrillation (AF) renders individual patients at risk for development of an atrial thrombus. The aim of this study was to determine clinical and echocardiographic factors influencing the risk of left atrial thrombosis (LAT) in patients with persistent nonvalvular AF. Genetic variants encoding haemostatic factors have been also assessed for putative association with LAT. In the cross-sectional study, a total of 212 patients (132 males and 80 females) with nonvalvular persistent AF (duration range 48 h-90 days) have been selected. LAT was visualized by transesophageal echocardiography. The FGB G(-455)A, PAI-1 4G/5G, F5 C(-224)T, and F5 R506Q genetic markers were tested using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) approach. To reveal independent factors contributing to the thromboembolic risk in AF, a multivariate logistic model was applied. LA thrombi were found in 44 out of 212 subjects (21%). LAT was more frequently observed in patients at age >75 years (P 75 years, LVEF
PubMed ID
20082208 View in PubMed
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Anatomic suitability for present and next generation transcatheter aortic valve prostheses: evidence for a complementary multidevice approach to treatment.

https://arctichealth.org/en/permalink/ahliterature141436
Source
JACC Cardiovasc Interv. 2010 Aug;3(8):859-66
Publication Type
Article
Date
Aug-2010
Author
Hasan Jilaihawi
Raoul Bonan
Anita Asgar
Réda Ibrahim
Tomasz Spyt
Derek Chin
Jan Kovac
Author Affiliation
Montreal Heart Institute, Montreal, Quebec, Canada.
Source
JACC Cardiovasc Interv. 2010 Aug;3(8):859-66
Date
Aug-2010
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Angiography
Aorta - pathology
Aortic Valve - ultrasonography
Aortic Valve Stenosis - diagnosis - therapy
Cardiac Catheterization - instrumentation
Echocardiography, Transesophageal
England
Femoral Artery - radiography
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation - instrumentation - methods
Humans
Patient Selection
Predictive value of tests
Prospective Studies
Prosthesis Design
Quebec
Severity of Illness Index
Treatment Outcome
Abstract
This study sought to assess the proportion of patients anatomically suitable for transcatheter aortic valve implantation by multiple access approaches.
The devices currently in mainstream use for transcatheter treatment of severe aortic stenosis are those of Edwards (Edwards Lifesciences, Nyon, Switzerland) and Medtronic CoreValve (M-C) (Luxembourg City, Luxembourg). The range of patients that these can presently treat requires elucidation to guide the necessary evolution of these technologies and increase their scope of therapy.
A consecutive series of patients were assessed with transthoracic or transesophageal echocardiography and invasive angiography to assess anatomical suitability by different approaches. The transfemoral access requirements for Edwards and M-C (Edwards currently 22- and 24-F, soon to be 18- and 19-F; M-C 18-F) as well as the aortic valve annular criteria (18 to 25 mm and 20 to 27 mm, respectively) were incorporated in this assessment. Patients unsuitable for the transfemoral approach were considered for Edwards transapical and M-C transaxillary and direct ascending aortic access. Patients suitable for these devices and access approaches were identified.
Data were analyzed for 100 consecutive patients. Edwards suitability was 28% for Edwards-Sapien transfemoral, 78% for Edwards Novaflex transfemoral, and 88% for Edwards-Sapien transapical. Medtronic CoreValve suitability was 84% for transfemoral and 89% using additional transaxillary and direct aortic approaches. Of the 12 patients unsuitable for Edwards-based procedures, 8 were suitable for M-C. Of the 11 patients unsuitable for M-C-based techniques, 8 were suitable for Edwards. Only 3% were anatomically unsuitable for all approaches.
In this series, 97% of patients were anatomically suitable for a complementary approach to treatment.
Notes
Comment In: JACC Cardiovasc Interv. 2010 Aug;3(8):867-920723860
PubMed ID
20723859 View in PubMed
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Availability of percutaneous closure for an adult population with interatrial shunts.

https://arctichealth.org/en/permalink/ahliterature53557
Source
Cardiology. 2003;99(2):85-9
Publication Type
Article
Date
2003
Author
Magnus Johansson
Björn Söderberg
Peter Eriksson
Author Affiliation
Department of Clinical Physiology, Ostra University Hospital, Göteborg, Sweden. magnus.c.johansson@vgregion.se
Source
Cardiology. 2003;99(2):85-9
Date
2003
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Balloon Occlusion
Cardiac Surgical Procedures - utilization
Echocardiography, Transesophageal
Female
Follow-Up Studies
Health Services Accessibility
Heart Septal Defects, Atrial - therapy
Humans
Male
Middle Aged
Patient Selection
Postoperative Complications - etiology - ultrasonography
Research Support, Non-U.S. Gov't
Sweden
Treatment Outcome
Abstract
OBJECTIVES: To report the availability of percutaneous closure for an adult population with interatrial septal defects. METHODS: Observational study with 66 consecutive patients referred to a tertiary center for evaluation of the possibility of percutaneous closure. The patients were selected initially after review of transesophageal echocardiography (TEE) and finally after heart catheterization. RESULTS: Out of 66 patients, 50 were selected after the review of TEE and 38 of them were selected after catheterization; all of the 38 were effectively closed. CONCLUSION: Percutaneous closure is possible and can be carried out safely in a majority of the adult population with interatrial shunts.
PubMed ID
12711883 View in PubMed
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Blood flow imaging in transesophageal echocardiography during atrial septal defect closure: a comparison with the current references.

https://arctichealth.org/en/permalink/ahliterature266382
Source
Echocardiography. 2015 Jan;32(1):34-41
Publication Type
Article
Date
Jan-2015
Author
Siri Ann Nyrnes
Lasse Løvstakken
Gaute Døhlen
Eirik Skogvoll
Hans Torp
Terje Skjaerpe
Gunnar Norgård
Stein Samstad
Torbjørn Graven
Bjørn Olav Haugen
Source
Echocardiography. 2015 Jan;32(1):34-41
Date
Jan-2015
Language
English
Publication Type
Article
Keywords
Blood Flow Velocity
Child
Child, Preschool
Echocardiography, Transesophageal - standards
Female
Heart Septal Defects, Atrial - physiopathology - surgery - ultrasonography
Humans
Infant
Infant, Newborn
Male
Norway
Preoperative Care
Pulmonary Veins - physiopathology - ultrasonography
Reference Values
Reproducibility of Results
Sensitivity and specificity
Abstract
Flow visualization before transcatheter atrial septal defect (ASD) closure is essential to identify the number and size of ASDs and to map the pulmonary veins (PV). Previous reports have shown improved visualization of ASD and PV using blood flow imaging (BFI), which supplements color Doppler imaging (CDI) with angle-independent information of flow direction. In this study, we compared transesophageal BFI with the current references in ASD sizing (balloon stretched diameter, BSD) and PV imaging (pulmonary angiography).
In this prospective study, 28 children were examined with transesophageal echocardiography (TEE) including BFI of the secundum ASD and the PV before interventional ASD closure. The maximum ASD diameter measured with BFI by 4 observers was compared to the corresponding BSD and CDI measurements. The repeatability of the BFI measurements was calculated as the residual standard deviation. BFI of the PV was compared to PV angiography.
The mean maximum diameter measured by BFI was 12.1 mm (±SD 2.4 mm). The corresponding BSD and CDI measurements were 15.9 mm (±SD 3.0 mm) and 11.8 mm (±SD 2.5 mm), respectively. The residual standard deviation was 1.2 mm. Compared to PV angiography, the sensitivity of BFI in detecting the correct entry of the PV was 0.96 (95% CI: 0.82-1.0).
Transesohageal echocardiography with BFI of the PV agreed well with pulmonary angiography. BFI had lower estimates for ASD size than BSD, but with acceptable 95% limits of agreement. The repeatability of the BFI measurements was close to the inherent ultrasound measurement error.
PubMed ID
24702696 View in PubMed
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Canadian guidelines for training in adult perioperative transesophageal echocardiography. Recommendations of the Cardiovascular Section of the Canadian Anesthesiologists' Society and the Canadian Society of Echocardiography.

https://arctichealth.org/en/permalink/ahliterature167078
Source
Can J Cardiol. 2006 Oct;22(12):1015-27
Publication Type
Article
Date
Oct-2006
Author
François Béïque
Mohamed Ali
Mark Hynes
Scott Mackenzie
André Denault
André Martineau
Charles MacAdams
Cory Sawchuk
Kristine Hirsch
Martin Lampa
Patricia Murphy
Georges Honos
Bradley Munt
Anthony Sanfilippo
Peter Duke
Author Affiliation
Department of Anesthesia, Sir Mortimer B Davis Jewish General Hospital, McGill University, Montreal, Quebec, Canada. fbeique@ana.jgh.mcgill.ca
Source
Can J Cardiol. 2006 Oct;22(12):1015-27
Date
Oct-2006
Language
English
Publication Type
Article
Keywords
Adult
Anesthesiology - education
Canada
Cardiology - education
Clinical Competence
Echocardiography, Transesophageal
Education, Medical, Continuing
Humans
Perioperative Care
Abstract
To establish Canadian guidelines for training in adult perioperative transesophageal echocardiography (TEE).
Guidelines were established by the Canadian Perioperative Echocardiography Group with the support of the cardiovascular section of the Canadian Anesthesiologists' Society in conjunction with the Canadian Society of Echocardiography. Guidelines for training in echocardiography by the American Society of Echocardiography, the American College of Cardiology and the Society of Cardiovascular Anesthesiologists were reviewed, modified and expanded to produce the 2003 Quebec expert consensus for training in perioperative echocardiography. The Quebec expert consensus and the 2005 guidelines for the provision of echocardiography in Canada formed the basis of the Canadian training guidelines in adult perioperative TEE.
Basic, advanced and director levels of expertise were identified. The total number of echocardiographic examinations to achieve each level of expertise remains unchanged from the 2002 American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists guidelines. The increased proportion of examinations personally performed at basic and advanced levels, as well as the level of autonomy at the basic level suggested by the Quebec expert consensus are retained. These examinations may be performed in a perioperative setting and are not limited to intraoperative TEE. Training 'on-the-job', the role of the perioperative TEE examination, the requirements for maintenance of competence and the duration of training are also discussed for each level of training. The components of a TEE report and comprehensive TEE examination are also outlined.
The Canadian guidelines for training in adult perioperative TEE reflect the unique Canadian practice profile in perioperative TEE and address the training requirements to obtain expertise in this field.
Notes
Cites: Anesth Analg. 2001 May;92(5):1126-3011323333
Cites: Can J Cardiol. 2005 Jul;21(9):763-8016082436
Cites: Anesth Analg. 2002 Jun;94(6):1384-812031993
Cites: J Am Soc Echocardiogr. 2002 Jun;15(6):647-5212050607
Cites: Anesth Analg. 2002 Dec;95(6):1476-82, table of contents12456404
Cites: J Am Coll Cardiol. 2003 Feb 19;41(4):687-70812598084
Cites: Circulation. 2003 Feb 25;107(7):1068-8912600924
Cites: J Am Soc Echocardiogr. 2003 Apr;16(4):379-40212712024
Cites: Anesth Analg. 2003 Aug;97(2):313-2212873911
Cites: Can J Anaesth. 2003 Aug-Sep;50(7):699-70612944445
Cites: Am J Cardiol. 1987 Jul 1;60(1):158-633604931
Cites: J Am Soc Echocardiogr. 1992 Mar-Apr;5(2):187-941571176
Cites: J Am Coll Cardiol. 1995 Jan;25(1):16-97798495
Cites: Anesth Analg. 1995 Aug;81(2):217-87618704
Cites: Anesth Analg. 1995 Aug;81(2):399-4037618735
Cites: Anesthesiology. 1996 Apr;84(4):986-10068638856
Cites: Anesth Analg. 1999 Oct;89(4):870-8410512257
Cites: J Am Soc Echocardiogr. 1999 Oct;12(10):884-90010511663
Cites: Anesth Analg. 2001 Dec;93(6):1422-7, table of contents11726417
PubMed ID
17036096 View in PubMed
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Canadian guidelines for training in adult perioperative transesophageal echocardiography. Recommendations of the Cardiovascular Section of the Canadian Anesthesiologists' Society and the Canadian Society of Echocardiography.

https://arctichealth.org/en/permalink/ahliterature167396
Source
Can J Anaesth. 2006 Oct;53(10):1044-60
Publication Type
Article
Date
Oct-2006
Author
François Béïque
Mohamed Ali
Mark Hynes
Scott MacKenzie
André Denault
André Martineau
Charles MacAdams
Corey Sawchuk
Kristine Hirsch
Martin Lampa
Patricia Murphy
Georges Honos
Bradley Munt
Anthony Sanfilippo
Peter Duke
Author Affiliation
SMBD Jewish General Hospital, 3755 chemin de la Côte Ste-Catherine, Montreal, Quebec H3T 1E2, Canada. fbeique@ana.jgh.mcgill.ca
Source
Can J Anaesth. 2006 Oct;53(10):1044-60
Date
Oct-2006
Language
English
Publication Type
Article
Keywords
Adult
Anesthesiology - education
Canada
Cardiology - education
Clinical Competence
Echocardiography, Transesophageal
Education, Medical, Continuing
Humans
Perioperative Care
Abstract
To establish Canadian guidelines for training in adult perioperative transesophageal echocardiography (TEE).
Guidelines were established by the Canadian Perioperative Echocardiography Group with the support of the cardiovascular section of the Canadian Anesthesiologists' Society (CAS) in conjunction with the Canadian Society of Echocardiography. Guidelines for training in echocardiography by the American Society of Echocardiography, the American College of Cardiology and the Society of Cardiovascular Anesthesiologists were reviewed, modified and expanded to produce the 2003 Quebec expert consensus for training in perioperative echocardiography. The Quebec expert consensus and the 2005 Guidelines for the provision of echocardiography in Canada formed the basis of the Canadian training guidelines in adult perioperative TEE.
Basic, advanced and director levels of expertise were identified. The total number of echocardiographic examinations to achieve each level of expertise remains unchanged from the 2002 American Society of Echocardiography-Society of Cardiovascular Anesthesiologists guidelines. The increased proportion of examinations personally performed at basic and advanced levels, and the level of autonomy at the basic level suggested by the Quebec expert consensus are retained. These examinations can be performed in a perioperative setting and are not limited to intraoperative TEE. Training "on the job", the role of the perioperative transesophageal echocardiography examination, requirements for maintenance of competence, and duration of training are also discussed for each level of training. The components of a TEE report and comprehensive TEE examination are also outlined.
The Canadian guidelines for training in adult perioperative TEE reflect the unique Canadian practice profile in perioperative TEE and address the training requirements to obtain expertise in this field.
Notes
Comment In: Can J Anaesth. 2006 Oct;53(10):969-7216987849
Comment In: Can J Anaesth. 2007 Feb;54(2):157-8; author reply 158-917272259
Erratum In: Can J Anaesth. 2006 Dec;53(12):1271
PubMed ID
16987861 View in PubMed
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Can structured clinical assessment using modified Duke's criteria improve appropriate use of echocardiography in patients with suspected infective endocarditis?

https://arctichealth.org/en/permalink/ahliterature184103
Source
Can J Cardiol. 2003 Aug;19(9):1017-22
Publication Type
Article
Date
Aug-2003
Author
Davinder S Jassal
Candace Lee
Candice Silversides
James W Tam
Author Affiliation
Department of Medicine, Dalhousie University, Halifax, Canada. umjassal@hotmail.com
Source
Can J Cardiol. 2003 Aug;19(9):1017-22
Date
Aug-2003
Language
English
Publication Type
Article
Keywords
Adult
Aged
Echocardiography - standards - statistics & numerical data
Echocardiography, Transesophageal - standards
Endocarditis, Bacterial - epidemiology - ultrasonography
Female
Follow-Up Studies
Humans
Likelihood Functions
Male
Manitoba
Middle Aged
Patient care team
Probability
Prospective Studies
Reproducibility of Results
Risk factors
Abstract
Although echocardiography has been incorporated into the diagnostic algorithm of patients with suspected infective endocarditis, systematic usage in clinical practice remains ill defined.
To test whether the rigid application of a predefined standardized clinical assessment using the Duke criteria by the research team would provide improved diagnostic accuracy of endocarditis when compared with usual clinical care provided by the attending team.
Between April 1, 2000 and March 31, 2001, 101 consecutive inpatients with suspected endocarditis were examined prospectively and independently by both teams. The clinical likelihood of endocarditis was graded as low, moderate or high. All patients underwent transthoracic echocardiography and appropriate transesophageal echocardiography if deemed necessary. All diagnostic and therapeutic outcomes were evaluated prospectively.
Of 101 consecutive inpatients (age 50+/-16 years; 62 males) enrolled, 22% subsequently were found to have endocarditis. The pre-echocardiographic likelihood categories as graded by the clinical and research teams were low in nine and 37 patients, respectively, moderate in 83 and 40 patients, respectively, and high in nine and 24 patients, respectively, with only a marginal agreement in classification (kappa=0.33). Of the 37 patients in the low likelihood group and 40 in the intermediate group, no endocarditis was diagnosed. In 22 of 24 patients classified in the high likelihood group, there was echocardiographic evidence of vegetations suggestive of endocarditis. Discriminating factors that increased the likelihood of endocarditis were a prior history of valvular disease, the presence of an indwelling catheter, positive blood cultures, and the presence of a new murmur and a vascular event. General internists, rheumatologists and intensive care physicians were more likely to order echocardiography in patients with low clinical probability of endocarditis, of which pneumonia was the most common alternative diagnosis.
Although prediction of clinical likelihood varies between observers, endocarditis is generally found only in those individuals with a moderate to high pre-echocardiographic clinical likelihood. Strict adherence to indications for transthoracic echocardiography and transesophageal echocardiography may help to facilitate more accurate diagnosis within the moderate likelihood category. Patients with low likelihood do not derive additional diagnostic benefit with echocardiography although other factors such as physician reassurance may continue to drive diagnostic demand.
PubMed ID
12915922 View in PubMed
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[Cardiac perforation following pacemaker implantation - a case series from Iceland].

https://arctichealth.org/en/permalink/ahliterature113718
Source
Laeknabladid. 2013 Apr;99(4):183-6
Publication Type
Article
Date
Apr-2013
Author
Ingvar Th Sverrisson
Jón Hognason
Halla Vidardottir
Gizur Gottskalksson
Gunnar Thór Gunnarsson
Jón Thór Sverrisson
Tómas Guðbjartsson
Author Affiliation
Department of Cardiothoracic Surgery, National University Hospital of Iceland, Reykjavik.
Source
Laeknabladid. 2013 Apr;99(4):183-6
Date
Apr-2013
Language
Icelandic
Geographic Location
Iceland
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cardiac Surgical Procedures
Chest Pain - etiology
Device Removal
Echocardiography, Transesophageal
Female
Heart Injuries - diagnosis - etiology - mortality - surgery
Humans
Iceland
Intensive Care Units
Male
Middle Aged
Pacemaker, Artificial - adverse effects
Pneumonia - etiology - mortality
Predictive value of tests
Sternotomy
Suture Techniques
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Abstract
Perforation of the heart is a serious complication following pacemaker implantation that can cause life threatening bleeding and cardiac tamponade. Here we describe five cases that were diagnosed in Iceland during a four year period.
This population-based case series includes five patients diagnosed with cardiac perforation following pacemaker insertion at Landspítali and Akureyri Hospital from January 1, 2007 to December 31, 2010. The mode of detection, treatment given and outcome were studied.
Altogether five patients (mean age 71 years, three females) were diagnosed with cardiac perforation in Iceland during the study period, one in 2008 and four in 2009. Chest pain was the most common presenting symptom (n=4) and no patient had acute cardiac tamponade. In all five cases the diagnosis was obtained with computed tomography scan or echocardiography. No perforation was detected intraoperatively but four of the cases were diagnosed within three weeks of the operation. Three patients were treated with surgical evacuation of blood via sternotomy and suture of the perforation. In the other two cases the pacemaker leads were removed in the operating room with trans-oesophageal echocardiographic guidance. Four patients survived the treatment and were discharged but one died of pneumonia in the intensive care unit.
Cardiac perforation is a serious complication and should be kept in mind in patients with chest pain following pacemaker insertion.
PubMed ID
23695968 View in PubMed
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Carotid artery and heart disease in subtypes of cerebral infarction.

https://arctichealth.org/en/permalink/ahliterature54841
Source
Stroke. 1994 Dec;25(12):2356-62
Publication Type
Article
Date
Dec-1994
Author
A. Lindgren
A. Roijer
B. Norrving
L. Wallin
J. Eskilsson
B B Johansson
Author Affiliation
Department of Neurology, University Hospital, Lund, Sweden.
Source
Stroke. 1994 Dec;25(12):2356-62
Date
Dec-1994
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Aged, 80 and over
Atrial Fibrillation - epidemiology
Carotid Artery Diseases - epidemiology - ultrasonography
Carotid Stenosis - epidemiology - ultrasonography
Case-Control Studies
Cerebral Infarction - classification - diagnosis - epidemiology
Comparative Study
Coronary Disease - epidemiology
Echocardiography
Echocardiography, Transesophageal
Electrocardiography
Embolism - epidemiology
Female
Follow-Up Studies
Heart Diseases - epidemiology - ultrasonography
Humans
Male
Middle Aged
Prevalence
Research Support, Non-U.S. Gov't
Risk factors
Sweden - epidemiology
Abstract
BACKGROUND AND PURPOSE: The aim of the study was to determine the prevalences of carotid artery disease and major and minor potential cardioembolic sources (1) in patients with cerebral infarction and age-matched control subjects and (2) in different clinical subtypes of cerebral infarction. METHODS: A series of 166 consecutive patients with cerebral infarction and 59 control subjects was examined. The study protocol included clinical subtyping of the cerebral infarctions, ultrasonography of the carotid arteries, transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), ECG, and examination of the brain with computed tomography, magnetic resonance imaging, or autopsy. RESULTS: Carotid artery stenosis > or = 80% or occlusion was present in 35 (21%) patients but in no control subjects (P or = 80% or occlusion, atrial fibrillation, or a major cardioembolic source detected at TTE or TEE was more frequent among patients with cortical symptoms from anterior or middle cerebral artery territories than among those with lacunar syndromes (66% versus 22%, respectively). The probable source of cerebral infarction was identified in most of the 166 patients: cardiac embolism in 28% of cases (n = 46), carotid artery disease in 8% (n = 14), both cardiac embolism and carotid artery disease in 7% (n = 11), and lacunar infarction in 23% (n = 38). In 57 (34%) of the patients no unequivocal cause of the cerebral infarction was found. CONCLUSIONS: The prevalences of carotid artery and heart disease differ significantly between clinical subtypes of cerebral infarction. The cause of cerebral infarction remains uncertain in one third of patients. Because a minor potential cardioembolic source occurs in about 50% of both patients and control subjects, this finding is of questionable value as a risk factor for stroke in the elderly.
PubMed ID
7974573 View in PubMed
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68 records – page 1 of 7.