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Transesophageal echocardiographic findings in stroke subtypes
G W Albers1, K A Comess, F A DeRook
1Stanford Stroke Center, Palo Alto, CA 94304-1705.
Insights
Transesophageal echocardiography is highly effective for detecting cardiac embolism sources in stroke patients, revealing significant findings in 46% of cases across various stroke subtypes. This cardiac imaging technique offers valuable insights for unexplained stroke evaluation.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Transesophageal echocardiography (TEE) is recognized for its high diagnostic yield in identifying cardiac sources of embolism, particularly in patients with cardioembolic risk factors or cryptogenic stroke.
- However, the utility of TEE in evaluating other stroke subtypes remains less understood.
Purpose of the Study:
- To assess the diagnostic yield of transesophageal echocardiography (TEE) in detecting potential cardiac sources of embolism across different stroke subtypes.
- To compare the findings of TEE with transthoracic echocardiography (TTE) in a cohort of stroke patients.
Main Methods:
- 145 consecutively admitted stroke patients were classified into stroke subtypes based on clinical evaluation, brain imaging, and carotid ultrasound.
- Both TEE and TTE were performed to identify specific cardiac abnormalities, including left atrial thrombi, spontaneous echo contrast, atrial septal aneurysm, interatrial shunts, ventricular thrombus/aneurysm, and myxomatous mitral valve.
Main Results:
- TEE identified at least one cardiac abnormality in 46% of patients, significantly higher than the 8% yield from TTE (P = .002).
- The diagnostic yield of TEE was substantial across all stroke subgroups studied.
- Specific findings varied by stroke subtype, with spontaneous echo contrast most frequent in patients with cardioembolic risk factors (P = .001), atrial septal aneurysms in lacunar syndromes (P = .012), and interatrial shunts common in all subtypes.
Conclusions:
- Transesophageal echocardiography demonstrates a high diagnostic yield for cardiac sources of embolism in stroke patients, irrespective of the stroke subtype.
- The prevalence and type of echocardiographic findings differ significantly among various stroke subgroups, highlighting the importance of tailored diagnostic approaches.
Background And Purpose:
Transesophageal echocardiography has a high yield for detecting potential cardiac sources of embolism in patients with clinical risk factors for cardioembolism or unexplained stroke. The yield in other stroke subtypes is unknown.
Methods:
We classified 145 consecutively admitted patients into stroke subtypes based on clinical findings, brain imaging, and carotid ultrasound. Both transesophageal and transthoracic echocardiography were performed to detect left atrial thrombi, spontaneous echo contrast, atrial septal aneurysm, interatrial shunts, ventricular thrombus or aneurysm, and myxomatous mitral valve.
Results:
Transesophageal echocardiography documented at least one of these findings in 46% of the patients compared with an 8% yield on the transthoracic study (P = .002). The yield of transesophageal echocardiography was substantial in all stroke subgroups. Patients with clinical risk factors for cardiac embolism had the highest frequency of spontaneous echo contrast (P = .001). Atrial septal aneurysms were most frequent in patients with lacunar syndromes (P = .012), and interatrial shunts were common in all stroke subtypes.
Conclusions:
Transesophageal echocardiographic findings vary considerably between stroke subgroups.