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[Cerebral ischemic events: when and how to look for a cardiac embolism source?]
P T Buser1, P Rickenbacher, M Zuber
1Abteilungen Kardiologie, Universitätskliniken Basel.
Insights
Transesophageal echocardiography (TEE) aids in diagnosing cardioembolic stroke sources. It
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Cerebral ischemic events are a leading cause of death and disability in industrialized nations.
- Identifying and treating preventable causes of stroke is crucial.
- Echocardiography, particularly transesophageal echocardiography (TEE), is valuable for detecting cardioembolic sources.
Purpose of the Study:
- To evaluate the utility of transesophageal echocardiography (TEE) in diagnosing cardioembolic sources in patients experiencing cerebral ischemic events.
- To define patient subgroups who would benefit most from TEE.
Main Methods:
- Review of echocardiographic diagnostic procedures for cardioembolic stroke.
- Comparison of transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) efficacy.
- Analysis of TEE indications based on patient age and clinical presentation.
Main Results:
- TEE is superior to TTE for identifying cardioembolic sources.
- TEE is recommended for patients under 50 with cerebral ischemic events.
- TEE offers no therapeutic advantage in patients over 70 with contraindications to anticoagulation.
- The decision to perform TEE in patients aged 50-70 requires individualized assessment.
Conclusions:
- Transesophageal echocardiography (TEE) is a key diagnostic tool for cardioembolic stroke, especially in younger patients.
- The routine use of TEE does not definitively improve prognosis in all patients with cerebral ischemic events.
- Clinical context and patient-specific factors guide the decision-making process for TEE utilization.
Abstract:
In industrialized countries, cerebral ischemic events rank third among the most frequent causes of death. In survivors, long-term disability may result. The diagnosis and therapy of preventable causes is therefore a major task. Echocardiography has proven to be most helpful in the search for cardioembolic sources, and the transesophageal approach (TEE) is superior to the transthoracic (TTE) in this specific indication. In patients in whom a cardioembolic source can be identified by clinical examination, 12-lead surface ECG or chest X-ray, an additional echocardiographic examination is not necessary. Patients under 50 with cerebral ischemic events should undergo TEE. In patients over 70 with a contraindication for long-term anticoagulant therapy, TEE has no therapeutic consequences and should therefore not be performed. In patients aged between 50 and 70 the diagnostic procedure of choice must be considered in each individual patient. It should be kept in mind that a more aggressive approach using TEE, from which therapeutic conclusions are drawn, has not clearly been shown to improve the prognosis of patients with cerebral ischemic events.