Importância do ecocardiograma transtorácico na avaliação de pacientes com acidente vascular cerebral isquêmico
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Data
2019-06-17
Autores
Teodoro, Robson Sarmento
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: O acidente vascular cerebral (AVC) isquêmico pode ser dividido etiologicamente em cinco tipos de acordo com a classificação TOAST e sua adequada investigação e caracterização pode auxiliar no manejo clínico e prevenção de novos eventos. O ecocardiograma transtorácico (ETT) é peça fundamental na investigação etiológica e cerca de um terço dos pacientes permanece sem definição adequada da etiologia ou são classificados como TOAST indeterminado. Objetivos: Avaliar se o percentual de indeterminação do TOAST diminui em função da realização do ecocardiograma transtorácico; avaliar se o prognóstico após o AVC isquêmico é pior entre pacientes que apresentam TOAST indeterminado e verificar a capacidade preditiva das variáveis ecocardiográficas sobre o prognóstico após AVC isquêmico. Metodologia: Coorte retrospectiva, na qual foram realizadas avaliações clínica, neurológica e ecocardiográfica durante internação por AVC e avaliação da mortalidade intra-hospitalar e da capacidade funcional no momento da alta hospitalar e após 90 dias. Foram realizados modelos de regressão linear múltipla e regressão logística múltipla ajustados pelos fatores confundidores. O nível de significância foi de 5%. Resultados: Foram incluídos 1100 pacientes, maioria do sexo masculino, 606 (55,09%), média de 68,1±13,3 anos de idade, em 977 (88,82%) pacientes foi realizado ETT e 448 (40,7%) tiveram classificação de TOAST indeterminado. Pacientes submetidos ao ecocardiograma transtorácico tiveram 3,1 vezes menos chance de ter o TOAST classificado como indeterminado (OR=0,32; p<0,001). A realização do ecocardiograma durante a internação foi fator protetor para mau prognóstico reduzindo em 11,8 vezes a chance de morte intra-hospitalar (OR:0,085; p<0,001) e a presença de TOAST indeterminado aumentou em 2,4 vezes a chance de mortalidade durante internação (OR:2,38; p=0,009). Conclusões: A realização do ecocardiograma durante internação por AVC isquêmico reduziu a possibilidade de TOAST indeterminado e o risco de mortalidade intra-hospitalar. A presença do TOAST indeterminado aumentou a chance de mortalidade durante internação mostrando a importância da realização deste exame no protocolo de investigação hospitalar dos pacientes com AVC isquêmico.
Background: Ischemic stroke can be divided etiologically into five types according to the TOAST classification, and its adequate investigation and characterization can aid in the clinical management and prevention of new events. Transthoracic echocardiography (TTE) plays a key role in etiological investigation, and about onethird of patients remain without adequate definition of the etiology or are classified as undetermined TOAST. Objectives: To evaluate if the percentage of indetermination of TOAST decreases according to the performance of the transthoracic echocardiography; to evaluate whether the prognosis after ischemic stroke is worse among patients with undetermined TOAST and to verify the predictive capacity of the echocardiographic variables on the prognosis after ischemic stroke. Methods: Retrospective cohort, in which clinical, neurological and echocardiographic evaluations were performed during stroke hospitalization and evaluation of in-hospital mortality and functional capacity at hospital discharge and after 90 days. Multiple linear regression and multiple logistic regression models were adjusted for confounding factors. The level of significance was 5%. Results: A total of 1100 patients were included, mostly male, 606 (55.09%), mean of 68.1 ± 13.3 years of age, and 977 (88.82%) patients were submitted to TTE and 448 (40.7%) had undetermined TOAST classification. Patients submitted to transthoracic echocardiography were 3.1 times less likely to have TOAST classified as undetermined (OR = 0.32, p <0.001). The echocardiography during hospitalization was a protective factor for poor prognosis, reducing the odds of inhospital death by 11.8 times (OR: 0.085; p <0.001) and the presence of undetermined TOAST increased by 2.4 times the chance of mortality during hospitalization (OR: 2.38; p = 0.009). Conclusions: The echocardiography during hospitalization for ischemic stroke reduced the possibility of undetermined TOAST and the risk of in-hospital mortality. The presence of undetermined TOAST increased the chance of mortality during hospitalization showing the importance of performing this test in the hospital investigation protocol of patients with ischemic stroke.
Background: Ischemic stroke can be divided etiologically into five types according to the TOAST classification, and its adequate investigation and characterization can aid in the clinical management and prevention of new events. Transthoracic echocardiography (TTE) plays a key role in etiological investigation, and about onethird of patients remain without adequate definition of the etiology or are classified as undetermined TOAST. Objectives: To evaluate if the percentage of indetermination of TOAST decreases according to the performance of the transthoracic echocardiography; to evaluate whether the prognosis after ischemic stroke is worse among patients with undetermined TOAST and to verify the predictive capacity of the echocardiographic variables on the prognosis after ischemic stroke. Methods: Retrospective cohort, in which clinical, neurological and echocardiographic evaluations were performed during stroke hospitalization and evaluation of in-hospital mortality and functional capacity at hospital discharge and after 90 days. Multiple linear regression and multiple logistic regression models were adjusted for confounding factors. The level of significance was 5%. Results: A total of 1100 patients were included, mostly male, 606 (55.09%), mean of 68.1 ± 13.3 years of age, and 977 (88.82%) patients were submitted to TTE and 448 (40.7%) had undetermined TOAST classification. Patients submitted to transthoracic echocardiography were 3.1 times less likely to have TOAST classified as undetermined (OR = 0.32, p <0.001). The echocardiography during hospitalization was a protective factor for poor prognosis, reducing the odds of inhospital death by 11.8 times (OR: 0.085; p <0.001) and the presence of undetermined TOAST increased by 2.4 times the chance of mortality during hospitalization (OR: 2.38; p = 0.009). Conclusions: The echocardiography during hospitalization for ischemic stroke reduced the possibility of undetermined TOAST and the risk of in-hospital mortality. The presence of undetermined TOAST increased the chance of mortality during hospitalization showing the importance of performing this test in the hospital investigation protocol of patients with ischemic stroke.
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Palavras-chave
acidente vascular cerebral, isquemia cerebral, ecocardiografia, cardioembolismo, stroke, ischemic stroke, echocardiography, cardioembolism