Clinical Relevance of Intracranial Microembolic Signals in Patients With Left Ventricular Assist Devices
| Autor: | Erich Bernd Ringelstein, Christof Schmid, D. Georgiadis, Hans H. Scheld, T. Mumme, T.G. Mackay, Darius G. Nabavi |
|---|---|
| Rok vydání: | 1996 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Ultrasonography Doppler Transcranial medicine.medical_treatment Ventricular Function Left law.invention Predictive Value of Tests law Internal medicine Cardiopulmonary bypass medicine Humans Clinical significance Postoperative Period Prospective Studies Prospective cohort study Advanced and Specialized Nursing Heart transplantation business.industry Incidence Anticoagulants Intracranial Embolism and Thrombosis Middle Aged medicine.disease Surgery Transplantation Embolism Predictive value of tests Cardiology Heart Transplantation Female Heart-Assist Devices Neurology (clinical) Cardiomyopathies Cardiology and Cardiovascular Medicine Complication business |
| Zdroj: | Stroke. 27:891-896 |
| ISSN: | 1524-4628 0039-2499 |
| DOI: | 10.1161/01.str.27.5.891 |
| Popis: | Background and Purpose The use of left ventricular assist devices has become an established method in bridging patients with end-stage cardiac failure to heart transplantation. Since thromboembolism is one of the major complications, we undertook this study to evaluate the clinical significance of Doppler microembolic signals (MES) in patients with left ventricular assist devices. Methods Six patients with left ventricular assist devices were monitored for MES with transcranial Doppler ultrasonography during the first 30 postoperative days. Additionally, repeated (10 per day and patient) and prolonged (3 hours per patient) monitorings were performed to assess the adequacy of the 30-minute recordings. Three observers evaluated 30 randomly assigned monitorings in a blinded fashion to assess the interobserver variability. The relation between MES counts and clinical, radiological, hemostaseological, and pump flow parameters and the predictive value of MES counts regarding the occurrence of embolic events was evaluated. Results Ten ischemic cerebrovascular accidents and 2 peripheral thromboembolic events occurred during the observation period of 177 days (total incidence, 6.8%). MES were found in 143 of 170 monitorings (84.1%). Their counts were significantly higher on days with clinically manifest embolic events as compared with event-free days (18.5 [3-74] versus 4 [0-52], respectively, median and 95% CI; P P P =.78 to .89, unpaired Student’s t test). Considerable short- and long-term intrapatient variations of MES counts, without consistent pattern, were noted. Conclusions Serial monitoring for MES is prognostically superior to single monitorings in patients with left ventricular assist devices. In the future, this new application mode may individually guide anticoagulation strategies and even influence the decision regarding early cardiac transplantation versus long-term use of the assist devices. |
| Databáze: | OpenAIRE |
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