Transesophageal echocardiography and stroke

Area of Science:

• Cardiology
• Neurology
• Medical Imaging

Background:

• Stroke is a leading cause of death in the US, necessitating accurate etiological diagnosis.
• Transesophageal echocardiography (TEE) is a cardiac ultrasound technique offering detailed anatomic and functional information.
• Identifying cardiac sources of embolism is a common, yet complex, indication for TEE.

Purpose of the Study:

• To evaluate the role of TEE in diagnosing stroke etiologies.
• To highlight TEE's sensitivity in detecting specific cardiac abnormalities linked to embolism.
• To emphasize the need for critical assessment of evidence supporting TEE findings in stroke workup.

Main Methods:

• Review of literature on transesophageal echocardiography for stroke cause identification.
• Analysis of TEE's efficacy in detecting atrial septal aneurysm, patent foramen ovale, and aortic atheroma.
• Consideration of the evidence base for various cardiac pathologies as embolic sources.

Main Results:

• TEE offers superior detail for cardiac anatomy and function relevant to cerebral ischemia.
• TEE demonstrates higher sensitivity than transthoracic imaging for detecting atrial septal aneurysm, patent foramen ovale, and aortic atheroma.
• The clinical validation and evidence strength for TEE-identified embolic sources vary significantly.

Conclusions:

• TEE is a valuable tool in the stroke workup for identifying potential cardiac sources of embolism.
• Careful interpretation of TEE findings is crucial, considering the varying levels of clinical evidence.
• Therapeutic decisions should integrate the confidence in the cause-and-effect relationship of identified cardiac pathologies.