Transesophageal echocardiographic findings in stroke subtypes.
OBJECTIVE
Transesophageal echocardiography has a high yield for detecting potential cardiac sources of embolism in patients with clinical risk factors for cardioembolism or unexplained stroke. The yield in other stroke subtypes is unknown.


METHODS
We classified 145 consecutively admitted patients into stroke subtypes based on clinical findings, brain imaging, and carotid ultrasound. Both transesophageal and transthoracic echocardiography were performed to detect left atrial thrombi, spontaneous echo contrast, atrial septal aneurysm, interatrial shunts, ventricular thrombus or aneurysm, and myxomatous mitral valve.


RESULTS
Transesophageal echocardiography documented at least one of these findings in 46% of the patients compared with an 8% yield on the transthoracic study (P = .002). The yield of transesophageal echocardiography was substantial in all stroke subgroups. Patients with clinical risk factors for cardiac embolism had the highest frequency of spontaneous echo contrast (P = .001). Atrial septal aneurysms were most frequent in patients with lacunar syndromes (P = .012), and interatrial shunts were common in all stroke subtypes.


CONCLUSIONS
Transesophageal echocardiographic findings vary considerably between stroke subgroups.
Albers
G W
GW
Stanford Stroke Center, Palo Alto, CA 94304-1705.
Comess
K A
KA
DeRook
F A
FA
Bracci
P
P
Atwood
J E
JE
Bolger
A
A
Hotson
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002561:Cerebrovascular Disorders / Q000145:classification / Q000150:complications / Q000000981:diagnostic imaging*; D003328:Coronary Thrombosis / Q000150:complications / Q000000981:diagnostic imaging; D004452:Echocardiography / Q000379:methods; D017548:Echocardiography, Transesophageal; D005260:Female; D006322:Heart Aneurysm / Q000150:complications / Q000000981:diagnostic imaging; D006325:Heart Atria; D006346:Heart Septum; D006801:Humans; D008297:Male; D008875:Middle Aged; D013909:Thorax