Embolic stroke and transoesophageal echocardiography: can clinical parameters predict the diagnostic yield?

The study was performed to determine whether age, cardiovascular risk factors or the stroke syndrome might define patients with embolic stroke for whom transoesophageal echocardiography (TEE) would prove to be useful. Of 256 patients from the Klosterneuburg Stroke Data Bank, 105 (40%) were included because of suspected embolic stroke (59 female, 46 male, mean age 64 years). A positive TEE finding was defined as the presence of left heart thrombus, valvular vegetation, right to left shunting or spontaneous echo contrast. TEE detected potential sources for embolism in 35 of the 105 patients. These were left atrial/appendage thrombi (n = 18), valvular vegetations (n = 4), right to left shunting (n = 10), and spontaneous echo contrast (n = 5). Only the presence of atrial fibrillation showed a significant association with the presence of a cardiac source of embolism (18/35 versus 22/70, P < 0.02). Age, cardiac disease, cardiovascular risk factors and the stroke syndrome did not help in distinguishing stroke patients with and without a positive TEE finding.