Feasibility and Clinical Utility of Transesophageal Echocardiography in the Acute Phase of Cerebral Ischemia

• Published in: The American journal of cardiology Vol. 106; no. 9; pp. 1339 - 1344
• Main Authors: De Castro, Stefano, MD, Papetti, Federica, MD, Di Angelantonio, Emanuele, MD, MSc, Razmovska, Biljana, MD, Truscelli, Giovanni, MD, Tuderti, Ursula, MD, Puca, Emanuele, MD, Correnti, Agata, MD, Fiorelli, Marco, MD, Prencipe, Massimiliano, MD, Toni, Danilo, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2010; Elsevier; Elsevier Limited
• Subjects: Acute Disease; Adult; Age; Aged; Biological and medical sciences; Brain Ischemia - diagnostic imaging; Brain Ischemia - etiology; Brain Ischemia - mortality; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular system; Chi-Square Distribution; Echocardiography, Transesophageal; Feasibility Studies; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Ischemia; Male; Medical sciences; Middle Aged; Neurology; Older people; Patients; Recurrence; Risk Factors; Severity of Illness Index; Stroke; Ultrasonic imaging; Ultrasonic investigative techniques; Vascular diseases and vascular malformations of the nervous system; Sonography; Nervous system diseases; Echocardiography; Phase; Acute; Cardiovascular disease; Cerebral disorder; Vascular disease; Central nervous system disease; Brain ischemia; Feasibility; Circulatory system; Cardiology; Cerebrovascular disease
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2010.06.066

We evaluated the feasibility and clinical utility of transesophageal echocardiography (TEE) in the early management of ischemic stroke. TEE was performed in consecutive patients with acute cerebral ischemia within 48 hours of symptoms onset. The data were analyzed by age (<55 vs ≥55 years), and the baseline stroke etiology was classified (determined vs undetermined). TEE was feasible in 660 (61%) of 1,080 patients. Left atrial abnormalities and complicated aortic plaques prevailed in older patients (p <0.05), irrespective of the stroke etiology. A patent foramen ovale prevailed in younger patients (p <0.05) but even in older patients was present in 13% of the determined and 31% of the undetermined stroke subgroups. Overall, high-risk and potentially high-risk cardioembolic sources were detected in 47% of the patients, and stroke etiology was consequently reviewed: 40% of the baseline undetermined strokes were reclassified as cardioembolic, and 29% of lacunar, 42% of large artery, and 30% of other determined-cause strokes were reclassified as concurrent etiology. Subsequently, according to the current guidelines, 12% of patients were reassigned from antiplatelet to anticoagulant therapy and 17% of patients were treated with high-dose statins; overall, secondary prevention treatment was modified in 26% of patients. In conclusion, TEE was feasible in about 2/3 of the patients investigated within 48 hours of the index event, contributed to stroke classification in 1/3 of cases, and guided secondary prevention therapy in 1/4 of patients. Therefore, TEE is useful for defining patients' risk profile for stroke recurrence.