[PP.17.23] IDENTIFICATION OF CARDIAC SOURCE OF EMBOLISM IN SECONDARY PREVENTION FOR ACUTE ISCHEMIC STROKE

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Abstract

Objective:

Stroke is the third leading cause of death and the first cause of handicap in the industrial country, little is known in our country regarding profile of our patients. Echocardiography transthoracic(TTE) and transoesophageal (TOE) are the cornerstone in the evaluation and diagnosis of these patients. Our objective is to identify source of embolism in our outpatient clinic.

Design and method:

from 2010 to2015, 164 patients (pts) with an acute ischemic stroke (110 Males, 78 Females mean age 55 ± 7 years (range 20–102) years), were included. All patients after clinical examination and electrocardiogram (ECG) were investigated by TTE and if needed by TOE to assess paradoxical embolization, left atrial appendage(LAA) velocity and aortic atherosclerosis. Aortic plaque more than 4 mm.

Results:

57% (94/164) were Hypertensive; 20 %(33/164) were diabetic; 18% (30) were both hypertensive and diabetic. In men, smoking history was reported in 40% of them. Mean body mass index (BMI) was 31 ± 5 kg/m2. On ECG 20 %(33/164) were on atrial fibrillation (AF), left ventricular hypertrophy was present in 57% (94/164). On TTE, 56% (92/164) had preserved ejection fraction (EF) and dilatation of the left atrium in 41%of the pts with presence of dense spontaneous echocontrast (SEC) with thrombi in 8 pts. Rheumatic valve disease (mitral stenosis) was present in 12% (20/164) and in addition,five pts had mitral prosthetic valve. 29% (48/164) underwent TOE showing SEC, low emptying velocity in 58% (28/48)of the pts and thrombi in nine of them. Plaque >4 mm in 18 % (9/48).

Results:

See Image of complex atheromatic aortic plaque on TEE

Conclusions:

All the patients underwent in the light of theirs clinical, TTE and if done on TOE data, recommendations about lifestyle measures, antihypertensive drugs, management of hyperglycemia, statins and optimization of anticoagulation therapy in pts with AF.

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