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Comparing the diagnostic value of Echocardiography In Stroke (CEIS) - results of a prospective observatory cohort
Marlena Schnieder1, Mohammed Chebbok2, Michael Didié2
1Department for Cardiology & Pneumology/Heart Center, University Medical Center Göttingen, Robert-Koch Straße 40, 37075, Göttingen, Germany. marlena.schnieder@med.uni-goettingen.de.
Insights
Transthoracic echocardiography (TTE) is as effective as transesophageal echocardiography (TEE) in detecting patent foramen ovale (PFO) in stroke patients. TTE can serve as a valuable screening tool, particularly for younger individuals, guiding therapeutic decisions.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Echocardiography is a key diagnostic tool in stroke workup.
- The comparative value of transthoracic echocardiography (TTE) versus transesophageal echocardiography (TEE) in stroke patients remains debated.
- This study aimed to evaluate TTE and TEE findings in stroke management and their impact on clinical decisions.
Purpose of the Study:
- To characterize echocardiographic findings in stroke patients.
- To correlate these findings with subsequent clinical decisions and therapies.
- To compare the efficacy of TTE and TEE in stroke management.
Main Methods:
- 107 patients with ischemic stroke or transient ischemic attack were evaluated.
- Patients underwent both TTE and TEE examinations by blinded investigators.
- Data on cardiac risk factors and therapeutic changes were collected.
Main Results:
- Major cardiac risk factors were identified in 8.2% of patients.
- A change in therapeutic regime occurred in 22.5% of cases post-echocardiography.
- Patent foramen ovale (PFO) detection led to major therapy changes, with similar rates for TTE (9.2%) and TEE (10.2%).
Conclusions:
- Detection of PFO is a major finding impacting stroke patient therapy.
- Transthoracic echocardiography (TTE) is non-inferior to transesophageal echocardiography (TEE) for PFO detection.
- TTE is a suitable screening tool for PFO, especially in young stroke patients.
Background:
Echocardiography is one of the main diagnostic tools for the diagnostic workup of stroke and is already well integrated into the clinical workup. However, the value of transthoracic vs. transesophageal echocardiography (TTE/TEE) in stroke patients is still a matter of debate. Aim of this study was to characterize relevant findings of TTE and TEE in the management of stroke patients and to correlate them with subsequent clinical decisions and therapies.
Methods:
We evaluated n = 107 patients admitted with an ischemic stroke or transient ischemic attack to our stroke unit of our university medical center. They underwent TTE and TEE examination by different blinded investigators.
Results:
Major cardiac risk factors were found in 8 of 98 (8.2%) patients and minor cardiac risk factors for stroke were found in 108 cases. We found a change in therapeutic regime after TTE or TEE in 22 (22.5%) cases, in 5 (5%) cases TEE leads to the change of therapeutic regime, in 4 (4%) TTE and in 13 cases (13.3%) TTE and TEE lead to the same change in therapeutic regime. The major therapy change was the indication to close a patent foramen ovale (PFO) in 9 (9.2%) patients with TTE and in 10 (10.2%) patients with TEE (p = 1.000).
Conclusion:
Major finding with clinical impact on therapy change is the detection of PFO. But for the detection of PFO, TTE is non inferior to TEE, implicating that TTE serves as a good screening tool for detection of PFO, especially in young age patients.
Trial Registration:
The trial was registered and approved prior to inclusion by our local ethics committee (1/3/17).
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