22. European Stroke Conference 400 Heart and brain Is routine investigation with transoesophageal echocardiography after cryptogenic stroke jus-tifiable? 498 © 2013 S. Karger AG, Basel Scientific Programme A.N. Jordan1, L Almond2, J Radvan3, J Kwan4 Royal Bournemouth Hospital, Bournemouth, UNITED KINGDOM1, Royal Bournemouth Hos-pital, Bournemouth, UNITED KINGDOM2, Royal Bournemouth Hospital, Bournemouth, UNITED KINGDOM3, Royal Bournemouth Hospital, Bournemouth, UNITED KINGDOM4 Background Embolism of cardiac origin accounts for 15-30% of ischaemic strokes, with frequent recurrence if the source is not identified and treated (1). Investigation with surface echocardiography (TTE) pro-vides a non-invasive method for evaluating embolic sources, though higher resolution data can be acquired through transoesophageal imaging (TOE) (2). We aimed to determine whether routine in-vestigation of stroke with TOE is warranted by comparing its diagnostic yield with surface imaging. Methods Retrospective analysis of patients presenting with stroke or TIA and undergoing both surface and transoesophageal echocardiography from 2007-2012. Agitated saline contrast was used at the discre-tion of the operator. Echocardiographic findings were noted and case notes examined for consequent changes in medication. Statistical significance was established at p<0.05 using McNemar’s test. Results Eighty patients were identified with a mean age of 60 years. 17% were receiving warfarin at the time of investigation. TOE identified a cardiac embolic source with more than twice the sensitivity of TTE (TOE 15%; TTE 7%; p=0.045). Patent foramen ovale was also demonstrated more commonly using transoesophageal imaging (TOE 25%; TTE 2%; p<0.01). A change in medication was initiated frequently after transoesophageal imaging, particularly in comparison with surface imaging (TOE 70%; TTE 29%; p<0.05). Conclusion TOE after stroke or TIA provides a high diagnostic yield and results in a change in management in the majority of subjects. This greatly exceeds the clinical impact of TTE in the same patient popu-lation. TOE, rather than surface imaging, should therefore be considered in all patients suspected of cardio-embolic stroke. References 1. Ferro JM: Cardioembolic stroke: an update. Lancet Neurol 2003;2:177-88. 2. Pepi, M et al.: Recommendation for echocardiography use in the diagnosis and management of cardiac sources of embolism. Eur J Echocardiogr 2010;11(10):461-476. 401 Heart and brain Clinic, pathogenesis and therapy features of cardiogenic stroke I.A. Grygorova1, O.A. Teslenko2, S.N. Grygorov3, N.S. Kufterina4 Kharkiv National Medical University, Kharkiv, UKRAINA1, Kharkiv National Medical Univer-sity, Kharkiv, UKRAINA2, Kharkiv National Medical University, Kharkiv, UKRAINA3, Kharkiv National Medical University, Kharkiv4 Background. Ischemic stroke (IS) is often the last point of the progression of different types of car-diovascular diseases. In our work comprehensively examined 500 patients with ischemic stroke in the acute phase. 41% of patients had cardiogenic pathogenetic mechanisms of IS developement. Were established clinical and diagnostic features of cardiogenic IS for optimization diagnostic, prog-nostic and therapeutic measures. Methods. Were used clinical-diagnostic, instrumental and biochemical methods. Results. Analysis of the nature of neurological symptoms has shown that 99.3% of patients had sud-den development of IS, focal symptoms were most pronounced at the time of its development. The most common mechanism for the development of IS was cardiogenic embolism. The most often was noticed atrial fibrillation, with an etiological factor in their development were coronary heart dis-ease (CHD), rheumatic heart disease, myocardial infarction, cardiomyopathy. In 84.4% of cases IS was located in the cortical branches of the middle cerebral artery. Results of the percentage study of erythrocyte membrane of phospholipid fractions showed the greatest changes of the lizoform phos-pholipids. They show an increase in “running” antioxidant system and developed membrane pathol-ogy. Regardless of heart disease, general patterns observed imbalance of neurotransmitter amino acids, which showed that the prevalence of inhibitory amino acids in the body than exciting.We ob-tained the formula for the evaluation of the risk of thrombotic complications of IS. It is based on the determination of lipids and lipoproteins of different classes in the blood plasma. Conclusions. Accordantly to the obtained results in the treatment of cardiogenic IS should be used cytoprotective preparations, neuroprotective and neurotrophic agents (Ceraxon), neuromodulators (Glycine), correctors of the energy metabolism (Actovegin).
Karger_ESC London_2013
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