[Transesophageal echography and systemic ischemic incidences: 235 cases]

Area of Science:

• Cardiology
• Neurology
• Medical Imaging

Background:

• Cerebral ischemic events and peripheral arterial embolism often lack a clear cardiac source on initial transthoracic echocardiography.
• Identifying the embolic source is crucial for effective stroke prevention strategies.

Purpose of the Study:

• To evaluate the diagnostic yield of transesophageal echocardiography (TEE) in identifying embolic sources in patients with ischemic events.
• To compare TEE findings between patients with and without a history of cardiovascular disease.

Main Methods:

• Transesophageal echocardiography was performed in 235 patients with cerebral ischemic events or peripheral arterial embolism.
• Patients were categorized into two groups: those with documented cardiac disease/atrial fibrillation and those without prior cardiovascular history.
• TEE findings, including intracardiac thrombus, spontaneous contrast, patent foramen ovale, atheromatous aortic plaques, and interatrial septal aneurysm, were analyzed.

Main Results:

• TEE revealed a potential embolic source in 65.9% of patients with cardiac disease versus 29.7% in those without (p < 0.001).
• Intracardiac thrombus and left atrial spontaneous contrast were significantly more frequent in patients with cardiac disease (p < 0.001).
• Patent foramen ovale was more prevalent in patients without a cardiac history (14.5% vs 4.1%, p < 0.01), often associated with interatrial septal aneurysm.

Conclusions:

• Transesophageal echocardiography is highly effective in detecting embolic sources, particularly in patients with known cardiac disease.
• In patients without prior cardiovascular history, TEE identified patent foramen ovale and interatrial septal aneurysms as significant risk factors for cerebral ischemic events.
• TEE is recommended for young patients or those experiencing recurrent ischemic events to identify potential cardiac sources.