title: Impact of transesophageal echocardiography on management in patients with suspected cardioembolic stroke.
abstract: Transesophageal echocardiography (TEE) is frequently performed in patients with acute ischemic cerebrovascular events to exclude a cardioembolic source. We aimed to determine the clinical impact of TEE on management. This is a retrospective single-center study of 1,458 consecutive patients hospitalized with acute ischemic stroke or transient ischemic attack who underwent TEE for evaluation of a suspected cardioembolic cause. Significant TEE findings were determined for each patient as recorded on the TEE report. The medical record was reviewed for baseline, clinical, and demographic variables and to determine whether significant management changes occurred as a result of the TEE findings. Potential significant changes in management included initiation of anticoagulation, placement of a patent foramen ovale (PFO) closure device, initiation of antibiotic therapy for endocarditis, surgical PFO closure, other cardiac surgery, and coil embolization of a pulmonary arteriovenous malformation. A significant change in management occurred in 243 patients (16.7%); 173 (71%) underwent treatment for PFO with a percutaneous PFO closure device (n = 100), initiation of chronic systemic anticoagulation (n = 68), or surgical PFO closure (n = 5). Additional findings leading to a change in management included endocarditis (n = 20), aortic arch atheroma (n = 14), intracardiac thrombus (n = 13), pulmonary arteriovenous malformation (n = 2), aortic valve fibroelastoma (n = 2), other valve masses (n = 4), and miscellaneous causes (n = 15). In conclusion, in patients with suspected cardioembolic stroke, TEE findings led to a change in management in 16.7% of patients. Of these, most (71%) were directed at prevention of subsequent paradoxical emboli in patients with PFO.
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City Missouri.
authors.forename: Yevgeniy
authors.initials: Y
authors.lastname: Khariton
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City Missouri.
authors.forename: John A
authors.initials: JA
authors.lastname: House
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City Missouri.
authors.forename: Lynn
authors.initials: L
authors.lastname: Comer
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City Missouri.
authors.forename: Tina R
authors.initials: TR
authors.lastname: Coggins
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City Missouri.
authors.forename: Anthony
authors.initials: A
authors.lastname: Magalski
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City Missouri.
authors.forename: David G
authors.initials: DG
authors.lastname: Skolnick
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City Missouri.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Good
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City Missouri. Electronic address: mmain@saint-lukes.org.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Main
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D004617:Embolism / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D055815:Young Adult