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Echocardiographic evaluation of patients with clinically suspected arterial emboli
T Hofmann1, W Kasper, T Meinertz
1Medizinische Klinik III, Albert-Ludwigs-Universität Freiburg, Germany.
Insights
Echocardiography frequently detects cardiovascular abnormalities in patients experiencing arterial embolic events. Transesophageal echocardiography significantly improves the detection of these critical findings, especially intracardiac masses.
Area of Science:
- Cardiovascular Medicine
- Diagnostic Imaging
- Neurology
Background:
- Arterial embolic events pose significant health risks, often originating from cardiovascular sources.
- Identifying the source of emboli is crucial for effective treatment and prevention of recurrent events.
Purpose of the Study:
- To evaluate the diagnostic yield of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in patients with arterial embolic events.
- To determine the prevalence of cardiovascular abnormalities in this patient cohort.
Main Methods:
- Prospective study of 153 patients (age 16-60) with arterial embolic events.
- Utilized both transthoracic and transesophageal echocardiography for cardiac assessment.
- Excluded patients over 60 and those with extracranial carotid artery disease.
Main Results:
- Cardiovascular abnormalities were common, found in 40% of patients after TTE and 58% after combined TTE/TEE.
- Intracardiac masses (e.g., vegetations) were identified in 25% of patients, particularly those with cerebral or peripheral embolism.
- Valvular disease (31%), interatrial septum abnormalities (15%), and thoracic aorta diseases (6%) were also frequently observed.
Conclusions:
- Echocardiography is highly valuable in diagnosing cardiovascular sources of arterial emboli.
- Transesophageal echocardiography significantly enhances the detection rate of intracardiac abnormalities compared to transthoracic echocardiography alone.
Abstract:
153 patients (mean age 42 years, range 16-60) who had arterial embolic events were examined prospectively by transthoracic and transoesophageal echocardiography. Patients older than 60 years and those with evidence of extracranial carotid artery occlusive disease were excluded. 84 patients had a cerebral ischaemic event, 50 patients had embolic events in an abdominal organ or limb, and 19 patients had acute retinal ischaemia. The transthoracic echocardiographic examination was normal in 92 patients (60%), whereas only 65 patients (42%) had normal findings after both transthoracic and transoesophageal examination (p less than 0.005). Intracardiac masses, including valvular vegetations, were found in 39 patients (25%), including 27% of patients with cerebral embolism and 32% of these with peripheral embolism, but in none of the patients with retinal ischaemia (p less than 0.001). 47 patients (31%) had valvular disease, 10 (7%) had wall motion abnormalities, 23 (15%) had abnormalities of the interatrial septum, and 9 patients (6%) had diseases of the thoracic aorta. Cardiovascular abnormalities were frequently found by echocardiography in patients with arterial emboli. The transesophageal technique significantly increased the chance of detecting such abnormalities, especially intracardiac masses.