title: The value of transesophageal echocardiography in the investigation and management of cryptogenic cerebral ischemia: a single-center experience.
abstract: The diagnostic utility of transesophageal echocardiography (TEE) has often been challenged in patients with cryptogenic stroke (CS). We estimated the prevalence of different findings on TEE examination of CS patients, their impact on secondary stroke prevention and the presence of potential age or gender disparities. We reviewed all TEE examinations that were performed in a single echocardiography laboratory during a 7-year-old period to identify CS patients that underwent investigation with TEE. Of the 518 total TEE examinations, we identified 88 CS patients. TEE revealed abnormal findings in 69.3 % of them. Patent foramen ovale (PFO) and atrial septal aneurysm (ASA) were identified in 30.6 and 22.7 % of the patients. Ascending aorta and aortic arch atheromatosis was present in 26.1 % of the patients, with complex atheromatosis diagnosed in 14.7 % of them. Cardiac myxomas were uncovered in 2.3 %. Thrombi in the left atrium and in cardiac valves were reported in 3.4 and 2.3 % of the patients, respectively. Based on TEE findings, the therapeutic management would be very likely modified in 9.1 % of the patients. Subgroup analysis revealed no gender disparities on the prevalence of TEE findings and in secondary stroke prevention, while linear regression analyses revealed significant associations of age with the prevalence of PFO, ASA, aorta atheromatosis and complex aorta atheromatosis. TEE examination should be included in the diagnostic work-up of all CS patients, irrespective of age and gender status, since it can reveal potential sources of embolism and has a significant impact for secondary stroke prevention.
authors.affiliation: Department of Neurology, University of Ioannina School of Medicine, University Campus, Ioannina, 45110, Greece. ar.katsanos@gmail.com.|Neurosurgical Research Institute, University of Ioannina, Ioannina, Greece. ar.katsanos@gmail.com.
authors.forename: Aristeidis H
authors.initials: AH
authors.lastname: Katsanos
authors.affiliation: Department of Cardiology, "Hatzikosta" General Hospital, Ioannina, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Patsouras
authors.affiliation: Second Department of Neurology, "Attikon" University Hospital, School of Medicine, University of Athens, Athens, Greece.|Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.|International Clinical Research Center, St. Anne's University Hospital in Brno, Brno, Czech Republic.
authors.forename: Georgios
authors.initials: G
authors.lastname: Tsivgoulis
authors.affiliation: First Division of Internal Medicine, University of Ioannina School of Medicine, Ioannina, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Kosmidou
authors.affiliation: Division of Gastroenterology, University of Ioannina School of Medicine, Ioannina, Greece.
authors.forename: Konstantinos H
authors.initials: KH
authors.lastname: Katsanos
authors.affiliation: Department of Neurology, University of Ioannina School of Medicine, University Campus, Ioannina, 45110, Greece.|Neurosurgical Research Institute, University of Ioannina, Ioannina, Greece.
authors.forename: Athanassios P
authors.initials: AP
authors.lastname: Kyritsis
authors.affiliation: Department of Neurology, University of Ioannina School of Medicine, University Campus, Ioannina, 45110, Greece.|Neurosurgical Research Institute, University of Ioannina, Ioannina, Greece.
authors.forename: Sotirios
authors.initials: S
authors.lastname: Giannopoulos
mesh_terms: D000367:Age Factors; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000517:prevention & control; D017548:Echocardiography, Transesophageal; D005260:Female; D054092:Foramen Ovale, Patent / Q000000981:diagnostic imaging / Q000453:epidemiology; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D055502:Secondary Prevention; D012727:Sex Characteristics; D020521:Stroke / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000517:prevention & control
keywords: Anticoagulation; Aorta atheromatosis; Cryptogenic stroke; Patent foramen ovale; Transesophageal echocardiography