Transesophageal echocardiography in various ischemic stroke subtypes

Area of Science:

• Cardiology
• Neurology
• Medical Imaging

Background:

• Cardioembolic strokes (CES) require precise identification of embolic sources.
• Transesophageal echocardiography (TEE) offers higher sensitivity than transthoracic echocardiography (TTE) for detecting cardiac sources of embolism.
• Understanding the prevalence of cardiac embolism sources and their relation to vascular risk factors is crucial for stroke management.

Purpose of the Study:

• To determine the prevalence of potential cardiac embolism sources detectable by TEE in an unselected ischemic stroke population.
• To investigate the relationship between TEE findings and vascular risk factors.
• To compare the diagnostic yield of TEE versus TTE in different stroke etiologies.

Main Methods:

• An unselected ischemic stroke population (108 patients) and a control group (26 individuals) were evaluated.
• Patients underwent both TTE and TEE examinations.
• Stroke patients were categorized into cardioembolic, atherothrombotic, and lacunar stroke groups.

Main Results:

• TEE revealed a higher prevalence of abnormal findings in stroke patients compared to controls (p < 0.001).
• TEE demonstrated significantly greater specificity and detection rates (74.0%) than TTE (10.2%) across all etiological groups (p < 0.001).
• Atrial fibrillation correlated with TEE abnormalities; left atrial spontaneous echo contrast was common in CES, while atherosclerotic aortic plaques were frequent in atherothrombotic stroke.

Conclusions:

• TEE is a valuable tool for detecting definite etiologies in cardioembolic stroke.
• TEE can identify associated cardiac pathologies in atherothrombotic and lacunar stroke.
• TEE findings can guide physicians in the treatment of ischemic stroke patients.