title: [Role of transesophageal echocardiography in the assessment and therapeutic management of patients with acute ischemic cerebral events before the age of 65].
abstract: BACKGROUND
  Ischemic stroke is the leading cause of mortality in Portugal, with around 30 to 50 % of cases being of cardioembolic etiology. Transesophageal echocardiography (TEE) has assumed growing importance in the detection of cardiac sources of embolism. However, there is controversy regarding the implications of TEE findings for the therapeutic approach to patients with ischemic stroke.
  
  
  OBJECTIVE
  To analyze TEE findings in the diagnostic work-up of patients with ischemic cerebral events and to determine their influence on therapeutic strategy.
  
  
  METHODS
  We retrospectively studied patients with stroke or transient ischemic attack (TIA) before the age of 65, of no apparent cause after carotid ultrasound, electrocardiogram and transthoracic echocardiography, who underwent TEE between 1992 and 2009. The following diagnoses on TEE were considered as potential embolic sources: atrial septal defect; patent foramen ovale (PFO); atrial septal aneurysm (ASA); vegetations; tumors; intracavitary thrombi; and aortic plaques >2mm (ascending aorta and arch).
  
  
  RESULTS
  We analyzed 294 patients, mean age 45 years, 56.8 % men. TEE revealed a potential cardioembolic source in 36.7 % of the patients, PFO and ASA being the most frequent. Throughout the period considered, there was an increase in the number of exams performed, as well as in diagnoses, mainly PFO and ASA. Comparison of patients with and without a diagnosis on TEE showed that the former were older and were more often prescribed oral anticoagulation. By multivariate analysis, the presence of a positive TEE finding was shown to be an independent predictor of treatment with oral anticoagulation (OR=2.48; CI 95%: 1.42-4.34; p=0.001).
  
  
  CONCLUSIONS
  In the population under analysis, TEE was useful in identifying potential cardioembolic sources and influenced the therapeutic strategy.
authors: Serviço de Cardiologia, Hospital de Braga, Braga, Portugal. antoniog80@portugalmail.com
authors: António
authors: A
authors: Gaspar
authors: Isabel
authors: I
authors: Silva
authors: António
authors: A
authors: Costeira Pereira
authors: Nuno
authors: N
authors: Salomé
authors: José
authors: J
authors: António Mariz
authors: Aida
authors: A
authors: Brandão
authors: Francisco
authors: F
authors: Fernandes
authors: Alda
authors: A
authors: Simões
authors: Alberto
authors: A
authors: Salgado
authors: Adelino
authors: A
authors: Correia
mesh_terms: D000208:Acute Disease; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*