Ecocardiograma transesofágico em pacientes com acidente vascular cerebral isquêmico
Arquivos
Data
2005
Autores
Fukujima, Marcia Maiumi 
Orientadores
Gabbai, Alberto Alain
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
O protocolo de pesquisa "Ecocardiograma transesofágico (ETE) e tratamento com
ácido acetil salicílico (AAS) de pacientes com acidente vascular cerebral (AVC)
isquêmico” está em andamento e como parte inicial é apresentada nesta tese o
artigo "Ecocardiograma transesofágico mostra fonte cardíaca não suspeitada em
pacientes com acidente vascular cerebral com mais que 45 anos", já que embolia
cerebral de fonte cardíaca é frequentemente relacionada a AVC em jovem.
OBJETIVO: descrever achados ecocardiográficos em jovens e não-jovens com AVC
isquêmico, sem suspeita de fonte cardíaca. MÉTODO: estudo prospectivo. 523
pacientes (267 homens e 256 mulheres) com AVC isquêmico sem evidência de fonte
cardíaca submeteram-se ao ecocardiograma transesofágico (ETE). RESULTADOS:
10% dos pacientes tinha 45 anos ou menos. Hipertrofia do ventrículo esquerdo,
aumento do átrio esquerdo, contraste espontâneo na aorta, aneurisma do septo
interatrial, calcificação da válvula mitral e aórtica, insuficiência aórtica e placas de
ateroma na aorta foram significantemente mais freqüentes nos pacientes com mais
que 45 anos; 2.8% dos não-jovens apresentaram trombo nas câmaras esquerdas.
CONCLUSÃO: ETE é amplamente sugerido na investigação de embolia em
pacientes jovens, porém parece ser tão importante também no grupo de pacientes
mais velhos, nos quais o risco de embolia cerebral é subestimado; etiologia
cardioembólica e aterosclerótica coexistem, e ambas devem ser identificadas e
tratadas para melhor prognóstico.
The clinical protocol "Transesophageal echocardiography and treatment with aspirin in patients with ischemic stroke" is going on, and, as an inicial part of it, we present the article "Transesophageal echocardiography discloses unexpected cardiac sources of embolus in stroke patients aged more than 45 years". Cerebral embolism from cardiac source is an important cause of stroke, specially in patients younger than 45 years old. Objective: to describe the TEE findings in young and no-young stroke patients without any prior evidence of cardiac source for cerebral embolism. Method: Transversal study. 523 patients (267 men and 256 women) with ischemic stroke, without any evidence of cardiac abnormality, underwent to transesophageal echocardiography (TEE). Results: Ten percent were aged 45 years or less. Left ventricle hypertrophy, left atrial enlargement, spontaneous contrast in aorta, interatrial septum aneurysm, mitral and aortic valve calcification, aortic valve regurgitation, and atherosclerotic plaques in aorta were significantly more frequent in patients aged more than 45 years. 2.8% of no-young patients had thrombus in left heart. Conclusion: TEE is widely used to diagnose cardiac source of cerebral embolism in young patients, but it seems to be as useful for older ones, in whom cerebral embolism risk is underestimated; atherogenic and cardioembolic causes may actually coexist, and both should be treated.
The clinical protocol "Transesophageal echocardiography and treatment with aspirin in patients with ischemic stroke" is going on, and, as an inicial part of it, we present the article "Transesophageal echocardiography discloses unexpected cardiac sources of embolus in stroke patients aged more than 45 years". Cerebral embolism from cardiac source is an important cause of stroke, specially in patients younger than 45 years old. Objective: to describe the TEE findings in young and no-young stroke patients without any prior evidence of cardiac source for cerebral embolism. Method: Transversal study. 523 patients (267 men and 256 women) with ischemic stroke, without any evidence of cardiac abnormality, underwent to transesophageal echocardiography (TEE). Results: Ten percent were aged 45 years or less. Left ventricle hypertrophy, left atrial enlargement, spontaneous contrast in aorta, interatrial septum aneurysm, mitral and aortic valve calcification, aortic valve regurgitation, and atherosclerotic plaques in aorta were significantly more frequent in patients aged more than 45 years. 2.8% of no-young patients had thrombus in left heart. Conclusion: TEE is widely used to diagnose cardiac source of cerebral embolism in young patients, but it seems to be as useful for older ones, in whom cerebral embolism risk is underestimated; atherogenic and cardioembolic causes may actually coexist, and both should be treated.
Descrição
Citação
FUKUJIMA, Marcia Maiumi. Ecocardiograma transesofágico em pacientes com acidente vascular cerebral isquêmico, 2005. 61 f. Tese (Doutorado em Ciências) – Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2005.