Transesophageal echocardiography in patients with ischemic stroke accurately detects significant coronary artery
S Voros1, N C Nanda, A K Samal
1Division of Cardiovascular Disease and the Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35249, USA.
Insights
Transesophageal echocardiography (TEE) accurately diagnoses coronary artery stenosis in ischemic stroke patients. This diagnostic capability significantly altered patient management, leading to interventions like coronary angiography and revascularization.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Neurology
Background:
- Ischemic stroke patients often undergo transesophageal echocardiography (TEE).
- Proximal coronary arteries can be visualized during TEE.
- Coronary artery disease is a significant comorbidity in ischemic stroke.
Purpose of the Study:
- To determine the accuracy of TEE in diagnosing proximal coronary stenosis among ischemic stroke patients.
- To assess if TEE findings for coronary stenosis influence patient management.
Main Methods:
- Retrospective study of 32 ischemic stroke patients who underwent TEE with proximal coronary examination.
- Comparison of TEE findings with coronary angiography results.
- Analysis of changes in patient management based on TEE results.
Main Results:
- High visualization rates for proximal coronary arteries: Left Main (97%), LAD (100%), LCx (94%), RCA (66%).
- Excellent diagnostic accuracy for significant stenosis: Sensitivity and specificity ranged from 95-100% across visualized vessels.
- TEE findings led to a change in management for 53% of patients, with 59% of those undergoing revascularization.
Conclusions:
- Transesophageal echocardiography is a highly accurate tool for detecting significant coronary artery disease in patients with ischemic stroke.
- TEE-based diagnosis of coronary stenosis prompts further investigation and can lead to timely revascularization, improving patient outcomes.
Objectives:
TEE is performed in many patients with ischemic stroke, and it is possible to examine the proximal coronaries by TEE in these patients. Our purpose was to (1) determine the accuracy of transesophageal echocardiography (TEE) in the diagnosis of proximal coronary stenosis in patients with ischemic stroke and (2) show that TEE detection of proximal coronary stenosis changed management in a substantial number of patients.
Methods:
Thirty-two patients with ischemic stroke undergoing TEE, in whom the proximal coronaries were examined and who had angiographic results available, were studied.
Results:
Proximal coronaries were visualized as follows: left main (LM) in 31 (97%), left anterior descending (LAD) in 32 (100%), left circumflex (LCx) in 30 (94%) and right coronary artery (RCA) in 21 (66%). The sensitivity and specificity of TEE in diagnosing significant coronary stenosis in visualized vessels were as follows: LM 100% and 100%, LAD 100% and 95%, LCx 100% and 96%, and RCA 100% and 100%, respectively. When visualized and nonvisualized segments were considered, TEE detected significant stenosis as follows: 4 of 5 in the LM (80%), 13 of 13 in the LAD (100%), 2 of 3 in the LCx (66%), and 2 of 8 in the RCA (25%). Of the 32 patients, TEE results changed management in 17 patients (53%). Angiographic findings resulted in 10 of the 17 patients (59%) undergoing revascularization.
Conclusions:
TEE was very accurate in diagnosing significant coexisting coronary artery disease in patients with ischemic stroke. TEE diagnosis of these lesions prompted coronary angiography and subsequent revascularization in a substantial number of patients.
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