title: Diagnostic and therapeutic value of echocardiography during the acute phase of ischemic stroke.
abstract: BACKGROUND
  Echocardiography is routinely used to identify potential cardiac sources of embolism (CSE) in the acute phase of ischemic stroke (IS). We know that transoesophageal echography (TEE) is superior to detect CSE than transthoracic echography (TTE). However, the indications of each technique remain controversial. We aimed to evaluate the diagnostic yield (DY) and the therapeutic impact (TI) of echocardiography (both techniques combined) in IS and to analyze impact of clinical factors on these values.
  
  
  METHODS
  We included consecutive IS patients over a period of 22 months. All patients underwent TTE, and selected patients (young or with a high suspicion of cardioembolic origin) then underwent TEE. DY (detection of CSE) and TI (introduction of oral anticoagulant, closure of patent foramen ovale and targeted cardiologic consultation) were systematically evaluated.
  
  
  RESULTS
  We analyzed 300 patients (mean age 61 years). All patients underwent TTE and 127 patients underwent TTE and TEE. Echocardiography overall detected CSE in 22% of patients with a TI in 11% of all cases. The TI was higher in patients less than or equal to 55 years of age. In contrast to other studies, the DY and TI of echocardiography were not associated with vascular risk factors.
  
  
  CONCLUSIONS
  Echocardiography, as currently practiced in our stroke unit, allows detection of CSE in one patient in five, and leads to change in therapy in half of these cases. Our results suggest that TTE should be used for all patients admitted for IS, and to limit the use of TEE to younger patients.
authors.affiliation: Service de neurologie, hôpital Bretonneau, CHRU Tours, TOURS Cedex 9, France. Electronic address: mariegaudron1@gmail.com.
authors.forename: Marie
authors.initials: M
authors.lastname: Gaudron
authors.affiliation: Service de neurologie, hôpital Bretonneau, CHRU Tours, TOURS Cedex 9, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bonnaud
authors.affiliation: Groupement d'imagerie médicale, unité médicale ultrasons, hôpital Bretonneau, CHRU Tours, TOURS Cedex 9, France.
authors.forename: Aaurélia
authors.initials: A
authors.lastname: Ros
authors.affiliation: Groupement d'imagerie médicale, unité médicale ultrasons, hôpital Bretonneau, CHRU Tours, TOURS Cedex 9, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Patat
authors.affiliation: Service de neurologie, hôpital Bretonneau, CHRU Tours, TOURS Cedex 9, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: de Toffol
authors.affiliation: INSERM CIC 0202, hôpital Bretonneau, CHRU Tours, TOURS Cedex 9, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Giraudeau
authors.affiliation: Service de neurologie, hôpital Bretonneau, CHRU Tours, TOURS Cedex 9, France.
authors.forename: Séverine
authors.initials: S
authors.lastname: Debiais
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging / Q000473:pathology*; D004452:Echocardiography / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods*; D004617:Embolism / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*
keywords: Transthoracic echography; diagnostic yield; echocardiography; stroke; therapeutic impact; transoesophageal echography