title: Impact of transesophageal echocardiography on clinical management of patients over age 50 with cryptogenic stroke and normal transthoracic echocardiogram.
abstract: BACKGROUND
  The utility of transesophageal echocardiography (TEE) subsequent to a normal transthoracic echocardiogram (TTE) in older patients with an unexplained stroke is uncertain.
  
  
  METHODS
  Two hundred sixty-three consecutive patients over the age of 50 years hospitalized with a clinical stroke confirmed with brain magnetic resonance imaging and a normal TTE were retrospectively analyzed. Patients with atrial fibrillation, atrial flutter, or any other causative reason for stroke were excluded. TEE was analyzed for findings that could explain the etiology of stroke as well as findings that would change therapy based on current guidelines.
  
  
  RESULTS
  Baseline characteristics included a mean age of 66.7 years (range, 50-91 years); 42.5% of patients were female. A possible etiology of stroke was discovered by TEE in 111 (42.2%) patients and included 1 or more of the following: complex plaque of the ascending aorta or arch, patent foramen ovale, atrial septal aneurysm, both atrial septal aneurysm and patent foramen ovale, or spontaneous contrast. Only 1 patient (0.4%) had a finding that changed immediate management, which was a thrombus in the left atrial appendage for which anticoagulation was prescribed. Follow-up was available at 6 months on 85 patients, of whom 13 (15%) had been discovered to have developed atrial fibrillation.
  
  
  CONCLUSIONS
  In our study population, when performed subsequent to a normal TTE in patients aged >50 years with cryptogenic stroke, TEE demonstrated a high diagnostic value, but had minimal incremental effect on patient management.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, New York Hospital Queens/Weill Medical College-Cornell University, Flushing, New York.
authors.forename: Brian
authors.initials: B
authors.lastname: Marino
authors.affiliation: Tulane University Heart and Vascular Institute, Tulane School of Medicine, New Orleans, Louisiana.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Jaiswal
authors.affiliation: Division of Cardiology, New York Hospital Queens/Weill Medical College-Cornell University, Flushing, New York.
authors.forename: Seth
authors.initials: S
authors.lastname: Goldbarg
authors.affiliation: Department of Neurology, New York Hospital Queens/Weill Medical College-Cornell University, Flushing, New York.
authors.forename: Gary L
authors.initials: GL
authors.lastname: Bernardini
authors.affiliation: Non-Invasive Cardiology and Cardiology Fellowship Program, Division of Cardiology, New York Hospital Queens/Weill Medical College-Cornell University, Flushing, New York.
authors.forename: Todd
authors.initials: T
authors.lastname: Kerwin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D006760:Hospitalization; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy