Transesophageal Echocardiography in Patients with Ischemic Stroke

Stroke is one of the most common causes of death and an important cause of disability. Detection and correct diagnosis of the source of emboli influences our recommendations and therapeutic outcome. There have been concerns regarding the routine use of transesophageal echocardiography (TEE) in these patients. This study examined the preference of TEE over transthoracic echocardiography (TTE) in the detection of cardiac embolic sources in patients suffering ischemic stroke.
The study population comprised 50 consecutive patients referred to the echocardiography laboratories for TEE with a diagnosis of stroke or transient ischemic
attack from Sep. 2001 through Nov. 2002. All the patients underwent both TTE and TEE.
There were 26 men and 24 women with a mean age of 40 ± 11.8 years. Forty-three patients (86%) were in sinus rhythm and 7 (14%) in atrial fibrillation. With TTE data, we were able to detect embolic sources with cardiac origin in 9 (18%) patients. When we added TEE examination, we found cardiac embolic sources in a further 17 (34%) patients. Finally, with TEE added to TTE, the total number of these patients rose from 9 to 26 (52%). This means TEE has significantly greater sensitivity than TTE in the detection of cardiac embolic sources in patients with ischemic stroke.
The present study suggests that the type of embolic source detectable by TEE may not reasonably be predicted on the basis of TTE findings; therefore, for the detection of embolic sources, TEE is preferred to TTE