Transesophageal Echocardiography in Patients of Acute Ischemic Stroke

Abstract

Background: Approximtely one third of cases of acute ischemic stroke are of undetermined etiology (cryptogenic). Among these cases, cardio embolic tend to be more severe than other causes. Transthoracic echocardiography is used as a standard imaging modality to study structural aspects of heart, however, transesophageal echocardiography (TEE) is a better and much more yielding modality. The present study was carried out in a tertiary care multispecialty hospital to enumerate the findings on TEE in the patients undergoing TEE for “cryptogenic stroke.” Methods: This retrospective observational study was done at our echo lab based on the TEE data of the last 10 years. Sixty-one consecutive adult patients admitted under department of neurology with a diagnosis of acute ischemic stroke and referred for TEE were included in the study. Results: Sixty one consecutive patients of cryptogenic acute ischemic stroke undergoing TEE were studied. Overall, 33% patients had grossly normal TEE findings. Patent foramen ovale (PFO) was the commonest abnormal finding present in 36%, atrial septal aneurysm (ASA) in 18% and both PFO and ASA were present in 18%. No statistical difference was noted between young (0-50 years) and elderly patients (>50 years) with respect to inter atrial septum abnormalities. Twenty eight percent had atheroma in descending aorta. Left atrial appendage clot or spontaneous echo contrast was present in 5% and vegetation was present in 5%. Conclusion: Dilated left atrium was present in 16% and left ventricular dysfunction was present in 18% of the patients. Our results reinforce the idea of a TEE examination in all patients of ischemic stroke which are not explained by routine clinical evaluation and transthoracic echo.

Electrocardiographic and Echocardiographic Findings of Patients With Non-hemorrhagic Stroke

“…Since the 5-year-recurrence rate of ischemic stroke after the first episode is estimated to be 30% (3), diagnostic workup can determine the underlying mechanism and contribute to the prevention of a second stroke (4). While the cardiac source of emboli accounts for 15%-40% of all strokes (5), cardiac emboli appear to cause more severe strokes compared to other types of ischemic strokes (6). Nevertheless, cardioembolism and recurrent stroke can be prevented in high-risk patients by a wide range of medications, including anticoagulants, antiarrhythmics, antihypertensives, and lipid-lowering agents (7).…”