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Multiplane transesophageal echocardiography and stroke
C Autore1, D Cartoni, M Piccininno
1Department of Cardiovascular and Respiratory Sciences, La Sapienza University of Rome, Italy.
The American Journal of Cardiology
|July 14, 1998
Summary
Transesophageal echocardiography (TEE) aids stroke evaluation by visualizing cardiac sources of embolism. However, its role in guiding cardioversion and identifying specific high-risk cardiac abnormalities like atrial septal aneurysm requires further prospective study.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Up to 40% of ischemic strokes are presumed to have a cardiac origin.
- Transesophageal echocardiography (TEE) is a key diagnostic tool for evaluating stroke patients.
- TEE provides superior imaging of posterior cardiac structures and the aorta.
Purpose of the Study:
- To review the current role and limitations of TEE in identifying cardiac sources of ischemic stroke.
- To address unresolved questions regarding TEE's utility in specific clinical scenarios, such as cardioversion and risk stratification.
- To highlight methodological challenges in current research and advocate for prospective studies.
Main Methods:
- Review of existing literature on TEE in stroke evaluation.
- Analysis of evidence linking cardiovascular abnormalities to ischemic stroke.
- Discussion of unresolved clinical questions and methodological considerations.
Main Results:
- TEE has identified associations between cardiac abnormalities (e.g., left-sided thrombi, aortic plaques) and ischemic stroke.
- Unresolved issues include TEE's role in predicting embolism after cardioversion and identifying high-risk patent foramen ovale.
- Prospective studies are needed to clarify the pathogenetic role of abnormalities like atrial septal aneurysm and patent foramen ovale.
Conclusions:
- While TEE is valuable, its precise role in managing atrial fibrillation cardioversion and stratifying stroke risk requires further investigation.
- Methodological limitations in current studies, often retrospective, bias findings.
- Prospective research with appropriate control groups is essential to establish reliable markers of embolic risk and refine the diagnosis of cardiogenic embolism.