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Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
[Diagnosis of cerebral embolism by transesophageal echocardiography]
A Mahagney1, D Sharif, B Weller
1Dept. of Neurology, Bnai Zion Hospital, Haifa.
Insights
Transesophageal echocardiography (TEE) significantly outperforms transthoracic echocardiography (TTE) in identifying cardiac sources of embolic stroke. This improved diagnosis is crucial for effective treatment in patients with ischemic stroke and normal carotid arteries.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Cerebrovascular events, particularly ischemic strokes, carry high mortality and morbidity, especially in the elderly.
- Cardiac embolism accounts for 30% of ischemic strokes, necessitating accurate source identification for targeted treatment.
- Clinical presentation of stroke may not always reveal the embolic origin, highlighting the need for advanced diagnostic tools.
Purpose of the Study:
- To compare the diagnostic efficacy of Transesophageal Echocardiography (TEE) and Transthoracic Echocardiography (TTE) in detecting cardiac sources of emboli in patients with ischemic stroke.
- To evaluate the prevalence of potential embolic sources identified by TEE and TTE in patients with ischemic stroke and normal carotid arteries compared to a control group.
Main Methods:
- A comparative study involving 65 patients with ischemic stroke and normal carotid arteries, and 50 control subjects without stroke.
- Both TEE and TTE were performed to identify potential cardiac sources of emboli.
- Data analysis focused on the detection rates of specific cardiac abnormalities between the patient and control groups.
Main Results:
- TEE identified potential embolic sources in 68% of ischemic stroke patients, significantly higher than the 15% detected by TTE.
- In the control group, TEE detected potential sources in 24% of individuals.
- Identified sources included left atrial clots, severe aortic atheroma, patent foramen ovale with paradoxical shunt, spontaneous echocardiographic contrast, vegetations, and mitral valve prolapse.
Conclusions:
- TEE is superior to TTE in detecting the cardiac etiology of embolic stroke in patients with normal carotid arteries.
- Accurate identification of the embolic source via TEE facilitates appropriate management and treatment strategies.
- The findings underscore the importance of TEE in the etiological diagnosis of cryptogenic ischemic stroke.
Abstract:
Cerebrovascular events have high mortality and morbidity, especially in the elderly. Ischemia is the main cause and 30% of the ischemic events are embolic and of cardiac origin. The clinical picture is not always typical of the type of stroke, but diagnosis of the mechanism of the event determines treatment. Transesophageal echocardiography (TEE) is a sensitive procedure more appropriate for diagnosing emboli of cardiac origin than transthoracic echocardiography (TTE). We therefore compared TEE and TTE in the determination of the source of emboli in 65 patients with ischemic stroke but without significant atherosclerotic changes in their carotid arteries, and compared these findings with those in 50 patients without stroke. 68% of the patients had potential sources of emboli according to TEE, compared to only 15% according to TTE. In the control group only 24% had potential sources of emboli by TEE. The findings were: clots in the left atrium, severe aortic atheroma, patent foramen ovale with paradoxical shunt, spontaneous echocardiography contrast, vegetations and mitral valve prolapse. The study showed that TEE is better than TTE in detecting the etiology of embolic stroke in those with normal carotid arteries, thus determining appropriate management.
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