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Transesophageal echocardiography for detecting intracardiac thrombi in embolic stroke
1Cerebrovascular and Cardiac Divisions, Department of Medicine, National Cardiovascular Center, Osaka, Japan.
Insights
Transesophageal echocardiography is superior for detecting small intracardiac thrombi in cardioembolic stroke patients. This method identified small left atrial appendage thrombi missed by other imaging techniques.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Cardioembolic stroke is often caused by intracardiac thrombi.
- Accurate detection of these thrombi is crucial for stroke management and prevention.
- Existing imaging methods may have limitations in identifying small thrombi.
Purpose of the Study:
- To evaluate the efficacy of transesophageal echocardiography (TEE) compared to transthoracic echocardiography (TTE) and ultrafast computed tomography (UCT) in detecting intracardiac thrombi.
- To assess the prevalence and location of intracardiac thrombi in patients with cardioembolic stroke.
Main Methods:
- Study included 56 patients with cardioembolic stroke.
- Transesophageal echocardiography and transthoracic echocardiography were performed.
- Ultrafast computed tomography was used in a subset of patients (n=9).
- Examinations were conducted within four weeks of stroke onset or in the chronic stage.
Main Results:
- Intracardiac thrombus was diagnosed in 7 patients and valvular vegetation in 1 patient using echocardiography criteria.
- Six thrombi were located in the left atrial appendage.
- Four small thrombi (<10 mm) in the left atrial appendage were detected by TEE but missed by TTE and UCT.
- All patients had underlying heart disease.
Conclusions:
- Transesophageal echocardiography is the most sensitive method for detecting small intracardiac thrombi, particularly in the left atrial appendage.
- TEE offers superior diagnostic performance compared to TTE and UCT for these specific findings.
- Early and accurate detection of intracardiac thrombi is vital for guiding anticoagulant therapy in stroke patients.
Abstract:
The authors studied 56 patients with cardioembolic stroke to search for intracardiac thrombi by use of transesophageal and transthoracic echocardiography. Forty consecutive patients were examined within four weeks of stroke onset and the remaining 16 in the chronic stage. They also performed ultrafast computed tomography in 9 of them. Underlying heart disease was present in all subjects. Anticoagulant therapy had already been started in 29 at the time of examinations. Using their own criteria for echocardiography, they diagnosed intracardiac thrombus in 7 cases and valvular vegetation in 1. Six thrombi were located in the left atrial appendage, 4 of which were smaller than 10 mm in diameter. These small thrombi were not found by either transthoracic echocardiography or computed tomography. Transesophageal echocardiography appears to be superior to the other two methods, especially for detecting small intracardiac thrombi in the left atrial appendage.