Transoesophageal echocardiography should be considered in patients with ischaemic stroke or transient ischaemic attack.
OBJECTIVE
In this present study, we tried to find out if there is a subgroup of patients that should not undergo transoesophageal echocardiography (TEE) after an ischaemic stroke or transient ischaemic attack (TIA).


METHODS
A total of 441 consecutive unselected patients with ischaemic stroke or TIA suitable for anticoagulation were examined with TEE in the acute phase. The patients were divided into five subcategories according to their rhythm, age and the findings in carotid sonography, and into two groups according to the presence of clinical risk factors for ischaemic stroke or TIA.


RESULTS
From the 441 studied patients, 60 (14%) had chronic or paroxysmal atrial fibrillation (AF) and 381 (86%) were in sinus rhythm (SR). Of the patients in SR, 46 (12%) were below 50 years old. The carotid sonography was conducted in 240 patients above 50 years old and in SR, and <50% internal carotid artery (ICA) stenosis was found in 194 (81%) patients and > or =50% ICA in 46 (19%) patients. Potential cardiac sources of embolism were found in patients both with AF or in SR (70% versus 46%), both below and above 50-year-old patients in SR (37% versus 47%), both in over 50-year-old patients in SR with <50% ICA stenosis and > or =50% ICA stenosis (41% versus 61%) and in patients in SR either without or with clinical risk factors for ischaemic stroke or TIA (43% versus 51%). On the basis of the TEE study, oral anticoagulation was started in 36 (9%) patients in SR.


CONCLUSIONS
These results support TEE in patients with ischaemic stroke or TIA who are candidates for receiving oral anticoagulation.
Strandberg
Marjatta
M
Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland. marjatta.strandberg@tyks.fi
Marttila
Reijo J
RJ
Helenius
Hans
H
Hartiala
Jaakko
J
D000925:Anticoagulants / Q000627:therapeutic use; D001146:Arrhythmia, Sinus / Q000150:complications / Q000000981:diagnostic imaging; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology; D002318:Cardiovascular Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology
D000925:Anticoagulants