Improved aetiological diagnosis of ischaemic stroke in a Vascular Medicine Unit - The significance of transesophageal echocardiogram

A. Martignoni, M. Sartori, L. Lanzarini, M. Negri, I. Martino, E. Benedicti, E. Marchesi, G. Bertone, C. Tinelli, F. Falaschi

Research output: Contribution to journalArticle

Abstract

Background: The TOAST study estimates that 34% of ischaemic strokes are of undetermined aetiology. Improvements in the diagnosis of the pathogenetic mechanism of ischaemic stroke would translate into a better care, in analogy to other fields of vascular and internal medicine. Objective: To measure the reduction of undetermined aetiology strokes performing a set of additional diagnostic tests. Design: Consecutive case series with historical controls. Setting: Internal Medicine Ward with a stroke area (SA) admitting most stroke patients of a large hospital in Italy. Subjects: A total of 179 ischaemic stroke patients admitted to SA in 2004-2005 compared with 105 ischaemic stroke patients admitted to the whole department in 2001. Intervention: To perform more diagnostic tests, including transesophageal echocardiography (TEE), in the greatest possible number of ischaemic stroke inpatients admitted in SA of the Internal Medicine Department, in the years 2004-2005. Results: More diagnostic tests were performed during the study period than in 2001, especially TEE (56% of patients in 2004-2005 vs. 3% of patients in 2001). We observed a significant reduction of undetermined aetiology from 38% in 2001 to 16% in 2004-2005 (p <0.0001), largely for an increased identification of cases of cardio-embolic mechanism (from 18% to 40%, p = 0.0002). In the years 2004-2005 the fraction of patients on anticoagulant treatment at discharge was 21% vs. 12% in 2001 (p = 0.041). Conclusion: Performing more tests, particularly TEE, brought improvements in the aetiological diagnosis of stroke, increasing cardio-embolism diagnosis and anticoagulant treatment.

Original languageEnglish
Pages (from-to)394-399
Number of pages6
JournalInternational Journal of Clinical Practice
Volume62
Issue number3
DOIs
Publication statusPublished - Mar 2008

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Cardiology
Stroke
Transesophageal Echocardiography
Internal Medicine
Routine Diagnostic Tests
Anticoagulants
Embolism
Italy
Inpatients

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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title = "Improved aetiological diagnosis of ischaemic stroke in a Vascular Medicine Unit - The significance of transesophageal echocardiogram",
abstract = "Background: The TOAST study estimates that 34{\%} of ischaemic strokes are of undetermined aetiology. Improvements in the diagnosis of the pathogenetic mechanism of ischaemic stroke would translate into a better care, in analogy to other fields of vascular and internal medicine. Objective: To measure the reduction of undetermined aetiology strokes performing a set of additional diagnostic tests. Design: Consecutive case series with historical controls. Setting: Internal Medicine Ward with a stroke area (SA) admitting most stroke patients of a large hospital in Italy. Subjects: A total of 179 ischaemic stroke patients admitted to SA in 2004-2005 compared with 105 ischaemic stroke patients admitted to the whole department in 2001. Intervention: To perform more diagnostic tests, including transesophageal echocardiography (TEE), in the greatest possible number of ischaemic stroke inpatients admitted in SA of the Internal Medicine Department, in the years 2004-2005. Results: More diagnostic tests were performed during the study period than in 2001, especially TEE (56{\%} of patients in 2004-2005 vs. 3{\%} of patients in 2001). We observed a significant reduction of undetermined aetiology from 38{\%} in 2001 to 16{\%} in 2004-2005 (p <0.0001), largely for an increased identification of cases of cardio-embolic mechanism (from 18{\%} to 40{\%}, p = 0.0002). In the years 2004-2005 the fraction of patients on anticoagulant treatment at discharge was 21{\%} vs. 12{\%} in 2001 (p = 0.041). Conclusion: Performing more tests, particularly TEE, brought improvements in the aetiological diagnosis of stroke, increasing cardio-embolism diagnosis and anticoagulant treatment.",
author = "A. Martignoni and M. Sartori and L. Lanzarini and M. Negri and I. Martino and E. Benedicti and E. Marchesi and G. Bertone and C. Tinelli and F. Falaschi",
year = "2008",
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TY - JOUR

T1 - Improved aetiological diagnosis of ischaemic stroke in a Vascular Medicine Unit - The significance of transesophageal echocardiogram

AU - Martignoni, A.

AU - Sartori, M.

AU - Lanzarini, L.

AU - Negri, M.

AU - Martino, I.

AU - Benedicti, E.

AU - Marchesi, E.

AU - Bertone, G.

AU - Tinelli, C.

AU - Falaschi, F.

PY - 2008/3

Y1 - 2008/3

N2 - Background: The TOAST study estimates that 34% of ischaemic strokes are of undetermined aetiology. Improvements in the diagnosis of the pathogenetic mechanism of ischaemic stroke would translate into a better care, in analogy to other fields of vascular and internal medicine. Objective: To measure the reduction of undetermined aetiology strokes performing a set of additional diagnostic tests. Design: Consecutive case series with historical controls. Setting: Internal Medicine Ward with a stroke area (SA) admitting most stroke patients of a large hospital in Italy. Subjects: A total of 179 ischaemic stroke patients admitted to SA in 2004-2005 compared with 105 ischaemic stroke patients admitted to the whole department in 2001. Intervention: To perform more diagnostic tests, including transesophageal echocardiography (TEE), in the greatest possible number of ischaemic stroke inpatients admitted in SA of the Internal Medicine Department, in the years 2004-2005. Results: More diagnostic tests were performed during the study period than in 2001, especially TEE (56% of patients in 2004-2005 vs. 3% of patients in 2001). We observed a significant reduction of undetermined aetiology from 38% in 2001 to 16% in 2004-2005 (p <0.0001), largely for an increased identification of cases of cardio-embolic mechanism (from 18% to 40%, p = 0.0002). In the years 2004-2005 the fraction of patients on anticoagulant treatment at discharge was 21% vs. 12% in 2001 (p = 0.041). Conclusion: Performing more tests, particularly TEE, brought improvements in the aetiological diagnosis of stroke, increasing cardio-embolism diagnosis and anticoagulant treatment.

AB - Background: The TOAST study estimates that 34% of ischaemic strokes are of undetermined aetiology. Improvements in the diagnosis of the pathogenetic mechanism of ischaemic stroke would translate into a better care, in analogy to other fields of vascular and internal medicine. Objective: To measure the reduction of undetermined aetiology strokes performing a set of additional diagnostic tests. Design: Consecutive case series with historical controls. Setting: Internal Medicine Ward with a stroke area (SA) admitting most stroke patients of a large hospital in Italy. Subjects: A total of 179 ischaemic stroke patients admitted to SA in 2004-2005 compared with 105 ischaemic stroke patients admitted to the whole department in 2001. Intervention: To perform more diagnostic tests, including transesophageal echocardiography (TEE), in the greatest possible number of ischaemic stroke inpatients admitted in SA of the Internal Medicine Department, in the years 2004-2005. Results: More diagnostic tests were performed during the study period than in 2001, especially TEE (56% of patients in 2004-2005 vs. 3% of patients in 2001). We observed a significant reduction of undetermined aetiology from 38% in 2001 to 16% in 2004-2005 (p <0.0001), largely for an increased identification of cases of cardio-embolic mechanism (from 18% to 40%, p = 0.0002). In the years 2004-2005 the fraction of patients on anticoagulant treatment at discharge was 21% vs. 12% in 2001 (p = 0.041). Conclusion: Performing more tests, particularly TEE, brought improvements in the aetiological diagnosis of stroke, increasing cardio-embolism diagnosis and anticoagulant treatment.

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