Study of transesophageal echocardiography in young patients (<40 years) with acute arterial ischemic stroke: A pilot...

The aim is to study cardiac abnormalities as detected by transesophageal echocardiography (TEE) in young patients (<40 years) presenting with acute ischemic arterial stroke.

A cross-sectional observational study was conducted in young patients aged <40 years presenting with acute arterial ischemic stroke without any valvular heart disease, prosthetic valve, or previously diagnosed atrial fibrillation (AF). TEE was performed in all eligible patients preferably within the first week of the onset of ischemic arterial stroke. All patients with normal TEE underwent holter to rule out paroxysmal AF.

Totally, 40 young patients were included in the study. Mean age was 35.17 (SD [standard deviation] ± 2.99) years. TEE abnormalities were noted in total 13 (32.5%) patients, of which patent foramen ovale was the most common cardiac abnormality in eight (20%) patients followed by left atrial appendage clot in three (7.5%) and atrial septal aneurysm in two (5%) patients. One patient (2.5%) was observed with atrial septal aneurysm along with a sieved septum. All the patients with normal TEE underwent holter, and four of 27 (14.8%) of these patients were noted to have paroxysmal AF.

Cardiac abnormalities on TEE and holter were detected in 42.5% of the young patients with idiopathic arterial stroke. TEE abnormality was noted in 33% (13/40), whereas AF on holter was seen in 14.8% (4/27) with normal TEE. Thus, probable cardioembolic stroke was responsible for acute ischemic stroke in 42.5% (17/40) of young patients in the absence of valvular heart disease, prosthetic valves, and persistent/permanent AF.