ADAM‐C score: New risk score for predicting diagnostic yield of transesophageal echocardiography after cerebral ischemia. Issue 8 (14th May 2018)

• Record Type: Journal Article
• Authors: Charbonnel, Clément; Jego, Christophe; Jourda, François; Vinsonneau, Ulric; Garçon, Philippe; Turlotte, Guillaume; Rivière, Jean François; Maurin, Marion; Lubret, Rémy; Meimoun, Patrick; Akret, Chrystelle; Cournot, Maxime; Sokic, Charles; Michel, Laurent; Lescure, Maryse; Kenizou, David; Melay, Marie; Fayard, Maxime; Gallet, Bruno; Fouche, Rémi; Janin‐Manificat, Luc; Dijoux, Nicolas; Martin, Anne Céline; Tho‐Agostini, Aurélia; Mann, Hubert; Ricard, Cécile; Pico, Fernando; Georges, Jean Louis; Belle, Loïc; Jourdain, Patrick
• Other Names: Convers‐Domart Raphaële investigator.; Baron Nicolas investigator.; Weingrod Michel investigator.; Stefas Lambros investigator.; Colonna Geneviève investigator.; Augusto Sandrine investigator.; Livarek Bernard investigator.; Schwob Jacques investigator.; Isorni Charles investigator.; Azowa Jean Baptiste investigator.; Soto François Xavier investigator.; Hadj Hamou Kamel investigator.; Ressencourt Olivier investigator.; Schaad Frédéric investigator.; Molins Guillaume investigator.; Boge Antoine investigator.; Goussot Samuel investigator.; Mouro Stéphane investigator.; Morel Yves investigator.; Mougenot Emmanuelle investigator.; Pichon Isabelle investigator.; Aroulanda Marie José investigator.; Murguet‐Badia Christine investigator.; Couleru Josette investigator.; Bernard Josette investigator.; Pagis Bruno investigator.; Fontan Anthony investigator.; Le Goanvic Christophe investigator.; Richaud Rainui investigator.; Lutinier Renaud investigator.; Moronval Frédéric investigator.; Brument Marion investigator.; Seghezzi Jean Christophe investigator.; Richard Benjamin investigator.; Chacornac Mathieu investigator.; Belle Loïc investigator.; Madiot Hend investigator.; Leddet Pierre investigator.; Ferrier Nadine investigator.; Chauvat Anthony investigator.; Cartigny Guillaume investigator.; Barbou Franck investigator.; Mariott Marion investigator.; Magnin Dominique investigator.; Napporn Gaby investigator.; Goralski Marc investigator.; Dibon Olivier investigator.; Miran Sophie investigator.;
• Is Part Of: Echocardiography. Volume 35:Issue 8(2018)
• Page Start: 1171
• Page End: 1182
• Publication Date: 2018-05-14
• Subjects: ischemic stroke -- transesophageal echocardiography; Echocardiography -- Periodicals; Echocardiography -- Periodicals; 616.1207543
• DOI: 10.1111/echo.14010
• Languages: English
• ISSNs: 0742-2822

Abstract

Abstract : Background and aim: The clinical utility of transesophageal echocardiography (TEE) after brain ischemia (BI) remains a matter of debate. We aimed to evaluate the clinical impact of TEE and to build a score that could help physicians to identify which patients should better benefit from TEE. Methods: This prospective, multicenter, observational study included patients over 18 years old, hospitalized for BI. TEE findings were judged discriminant if the results showed important information leading to major changes in the management of patients. Most patients with patent foramen ovale were excluded. Variables independently associated with a discriminant TEE were used to build the prediction model. Results: Of the entire population (1479 patients), 255 patients (17%) were classified in the discriminant TEE group. Five parameters were selected as predictors of a discriminant TEE. Accordingly, the ADAM‐C score could be calculated as follows: Score = 4 (if age ≥60) + 2 (if diabetes) + 2 (if aortic stenosis from any degrees) + 1 (if multi‐territory stroke) + 2 (if history of coronary artery disease). At a threshold lower than 3, the sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of detecting discriminant TEE were 88% (95% CI 85–90), 44% (95% CI 41–47), 21% (95% CI 19–27), and 95% (95% CI 94–97), respectively. Conclusion: A simple score based on clinical and transthoracic echocardiographic parameters can help physicians to identify patients who might not benefit from TEE. Indeed, a score lower than 3 has an interesting NPV of 95% (95% CI 94–97).