Incidence of transcranial Doppler-detected cerebral microemboli in patients referred for echocardiography.
OBJECTIVE
Transcranial Doppler can detect cerebral microemboli. These emboli may be a risk factor for embolic stroke. We studied the prevalence of microemboli in patients referred for echocardiography.


METHODS
Forty-two patients were evaluated. Patients were studied with continuous monitoring over one middle cerebral artery for 30 minutes, and the number of microemboli was recorded. Patients were divided into three groups, those with prosthetic heart valves (group A, n = 15), atrial fibrillation (group B, n = 14), and no major cardiac risk factor (group C, n = 14).


RESULTS
Seventeen percent (7 of 42) of all patients had microemboli. In group A, 5 of 15 (33%) had microemboli. In group B, 2 of 13 (15%) patients had microemboli. Twenty-five percent (7 of 28) of patients in groups A and B combined (A+B) had microemboli. No patients (0 of 14) in group C had microemboli. Groups A and A+B had significantly more emboli than group C (P < .05). Prosthetic heart valve patients with emboli more commonly had a history of prior stroke than valve patients without emboli (3 of 5 versus 2 of 10). The number of emboli seen per 30-minute monitoring session was greater in patients with a prior history of stroke than in patients without (10 microemboli versus 3).


CONCLUSIONS
Microemboli can be found in a significant percentage of selected patients referred for echocardiography. The prevalence of microembolism is greater in patients with a known high risk of embolization (eg, prosthetic valves) and less in patients with a lower risk of embolization (eg, atrial fibrillation). These microemboli may be associated with an increased prevalence of previous stroke in patients with prosthetic valves.
Department of Neurology and Neurological Sciences, Stanford University Medical Center, Palo Alto, CA.
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DC
Tong
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Bolger
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Albers
D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000209:etiology; D004452:Echocardiography; D006350:Heart Valve Prosthesis; D006801:Humans; D015994:Incidence; D002542:Intracranial Embolism and Thrombosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012016:Reference Values; D012017:Referral and Consultation; D012307:Risk Factors; D017585:Ultrasonography, Doppler, Transcranial