Transoesophageal echocardiography in patients with acute stroke with sinus rhythm and no cardiac disease history.
BACKGROUND
Transoesophageal echocardiography (TOE) is the gold standard for detecting potential cardiac sources of embolism (PCSE). However, the role of TOE in patients with ischaemic stroke with normal sinus rhythm (NSR) and no cardiac disease remains uncertain.


METHODS
The authors retrospectively analysed 1833 consecutive patients with ischaemic stroke with NSR and no history of cardiac disease who were examined by TOE. The authors investigated the frequency of PCSE and aortic plaques detected in these patients. Determination of high- and medium-risk PCSE was based on the Trial of ORG 10172 in the Acute Stroke Treatment classification. The authors also determined how the proportions of stroke subtypes and treatment strategies based on current guidelines have been changed after TOE.


RESULTS
PCSE and/or aortic plaques were detected in 753 (41.1%) of 1833 patients. After TOE, a total of 355 PCSE (45 high-risk PCSE and 310 medium-risk PCSE) were found in 323 patients (17.6%). Aortic plaques were found in 502 patients (27.4%). Among these, complex aortic plaques, which are significant sources of embolism, were found in 157 patients (8.5%). Changes in treatment strategies for secondary prevention based on the current guidelines would have been necessary in 63 patients (3.4 %) after TOE examination.


CONCLUSIONS
Potential embolic sources from the heart and aorta can be detected by TOE examination in many patients with stroke with NSR and no cardiac disease, which enables a better determination of stroke mechanisms.
Cho
Hyun-Ji
HJ
Department of Neurology, Yonsei University College of Medicine, 250 Seongsan-no, Seodaemoon-gu, Seoul 120-752, Korea.
Choi
Hye-Yeon
HY
Kim
Young Dae
YD
Nam
Hyo-Suk
HS
Han
Sang Won
SW
Ha
Jong Won
JW
Chung
Nam-Sik
NS
Heo
Ji Hoe
JH
D000208:Acute Disease; D000465:Algorithms; D017548:Echocardiography, Transesophageal / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000502:physiology*; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012849:Sinoatrial Node / Q000502:physiology*; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed