title: [Systematic implementation of transthoracic echocardiography, transesophageal echocardiography and 24-hour Holter ECG for the detection of cardiac sources of embolism in patients with stroke or transient ischemic attack. A retrospective study of 220 patients].
abstract: BACKGROUND
  Embolism of cardiac origin accounts for around 20% of ischemic strokes. ECG and transthoracic echocardiography (TTE) are commonly obtained during the evaluation of patient of ischemic stroke but specific indications for the transesophageal (TEE) echocardiography and 24-hour Holter ECG (Holter) remain uncertain.
  
  
  OBJECTIVE
  The aim of this study is to report the contribution of TTE, TEE and Holter performed as a routine during the evaluation of patients with ischemic stroke (IS) or transient ischemic attack (TIA).
  
  
  METHODS
  This is a retrospective single-center study of 220 patients hospitalized between 1st January 2007 and 31st December 2010 for a first IS or TIA.
  
  
  RESULTS
  One hundred and forty-three IS and 77 TIA are identified. The average age of patients was 66 years (18-88 years). TTE/TEE/24-hour Holter allowed the diagnosis of cardiac sources of embolism in 135 patents (61.3%). TTE/TEE identified potential source of cardiogenic embolism in 126 patients (52.2%). Twenty four-hour Holter ECG tracked supraventricular arrhythmia in 15 patients (6.7%), 9 (4%) which had non-contributory ultrasound assessment.
  
  
  CONCLUSIONS
  The systematic implementation of TTE/TEE/Holter is useful for identifying potential sources of cardiogenic embolism. The performance of TEE remains above the TTE. Holter should be recommended because it is a cost effective and non-invasive tool.
authors: Service de cardiologie, hôpital d'instruction des armées Clermont-Tonnerre, BCRM de Brest CC 41, 29240 Brest cedex 9, France. Electronic address: ulric.vinsonneau@orange.fr.
authors: U
authors: U
authors: Vinsonneau
authors: Service de neurologie, hôpital d'instruction des armées Clermont-Tonnerre, BCRM de Brest CC 41, 29240 Brest cedex 9, France.
authors: A
authors: A
authors: Leblanc
authors: Service de cardiologie, hôpital d'instruction des armées Clermont-Tonnerre, BCRM de Brest CC 41, 29240 Brest cedex 9, France.
authors: J-F
authors: JF
authors: Buchet
authors: Service de cardiologie, hôpital d'instruction des armées Clermont-Tonnerre, BCRM de Brest CC 41, 29240 Brest cedex 9, France.
authors: V
authors: V
authors: Pangnarind-Heintz
authors: Centre d'investigation clinique, centre hospitalier universitaire La Cavale-Blanche, 29200 Brest, France.
authors: G
authors: G
authors: Le Gal
authors: Service de cardiologie, hôpital d'instruction des armées Clermont-Tonnerre, BCRM de Brest CC 41, 29240 Brest cedex 9, France.
authors: G
authors: G
authors: Rohel
authors: Service de cardiologie, hôpital d'instruction des armées Clermont-Tonnerre, BCRM de Brest CC 41, 29240 Brest cedex 9, France.
authors: N
authors: N
authors: Paleiron
authors: Service de cardiologie, hôpital d'instruction des armées Clermont-Tonnerre, BCRM de Brest CC 41, 29240 Brest cedex 9, France.
authors: M
authors: M
authors: Piquemal
authors: Service de neurologie, hôpital d'instruction des armées Clermont-Tonnerre, BCRM de Brest CC 41, 29240 Brest cedex 9, France.
authors: C
authors: C
authors: Blanchard
authors: Service de neurologie, hôpital d'instruction des armées Clermont-Tonnerre, BCRM de Brest CC 41, 29240 Brest cedex 9, France.
authors: F
authors: F
authors: Zagnoli
authors: Service de cardiologie, hôpital d'instruction des armées Clermont-Tonnerre, BCRM de Brest CC 41, 29240 Brest cedex 9, France.
authors: P
authors: P
authors: Paule
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D015716:Electrocardiography, Ambulatory; D004617:Embolism / Q000209:etiology*; D005260:Female; D006331:Heart Diseases / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology*; D055815:Young Adult
keywords: 24-hours Holter ECG; Accident vasculaire cérébrale ischémique; Cardiac embolism; Cardiopathie emboligène; Echocardiography; Holter ECG; Ischemic stroke; Échographie cardiaque