Transoesophageal echocardiography in patients with stroke and low risk of embolic etiology

Transoesophageal echocardiography (TEE) is currently the gold standard in the diagnosis of cardiac sources of embolization and the frequently discussed question is whether all patients with suspected embolic stroke should be screened by TEE. Based on the results of transthoracic echocardiography (TTE), we determined the significance of TEE in patients with ischemic stroke with low risk of embolic etiology. We made a retrospective evaluation of TEE examination in the period from 1(st) January 2000 to 31(st) December 2003 in patients with ischemic stroke and sinus rhythm and normal left ventricular function. TEE examination was done in 159 patients. A quarter of the patients had pathological findings in the heart: left atrial thrombus in nine (5.7%), spontaneous echocontrast in left atrium in 14 (8.8%), patent foramen ovale in 16 (10%) and other findings in seven (4.4%) patients. The finding of the thrombus or echocontrast in the left atrium correlated with the size of the left atrium and it was proved in the patients with left atrium of size above 39 mm. On the contrary, patent foramen ovale was found in younger patients (70 vs. 59 years). Our results have shown that TEE is of low relevance to patients with a normal transthoracic echocardiogram.