Cardiac sources of embolism should be routinely screened in ischemic colitis.
OBJECTIVE
Potential cardiac sources of embolism may promote ischemic colitis. The aim of this study was to evaluate their role in segmental, nongangrenous ischemic colitis and to determine the usefulness of routine cardiac evaluation in patients with this disease.


METHODS
Sixty case and 60 control patients matched for age and gender were included and questioned regarding treatment and prior cardiovascular history or risk factors. Potential cardiac sources of embolism, classified as "proven" or " still debated," were screened using an electrocardiogram, rhythmic Holter monitoring over 24 h, and transthoracic echocardiography.


RESULTS
Sex ratio (male:female) was 1:2, and mean age was 70 +/- 14 yr. Case and control patients had similar drug use, prior cardiovascular history, and risk factors. A potential cardiac source of embolism was found in 26/60 case (43%), compared with 14/60 control patients (23%) (p = 0.02; OR = 2.5, 95% CI = 1.2-5.5). Excluding the "still debated," 21/60 case (35%), compared with 8/60 control patients (13%), had a "proven" cardiac source of embolism (p < 0.01; OR = 3.5, 95% CI = 1.4-8.4). Electrocardiogram alone misdiagnosed 72% of the "proven" cardiac sources of embolism, whereas the combination electrocardiogram plus Holter monitoring detected 71%, and electrocardiogram plus echocardiography 62%. Twelve of 21 case patients with at least one proven cardiac source of embolism, were previously unknown. Anticoagulant therapy was required in 32% of case patients and antiarrhythmic therapy in 25% of cases.


CONCLUSIONS
Potential cardiac sources of embolism were more common in patients with segmental, nongangrenous ischemic colitis than in control patients. Therefore, these patients should undergo a routine electrocardiogram, rhythmic Holter monitoring, and transthoracic echocardiography. Anticoagulant therapy should also be considered for this patient population.
Hourmand-Ollivier
Isabelle
I
Services d'Hépatogastroentérologie et de Nutrition, Centre Hospitalier Universitaire Côte de Nacre, Caen, France.
Bouin
Mickael
M
Saloux
Eric
E
Morello
Remi
R
Rousselot
Pierre
P
Piquet
Marie-Astrid
MA
Dao
Thong
T
Verwaerde
Jean-Claude
JC
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D016022:Case-Control Studies; D017091:Colitis, Ischemic / Q000209:etiology*; D003331:Coronary Vessels; D003951:Diagnostic Errors; D004452:Echocardiography; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D004617:Embolism / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies
D000925:Anticoagulants