title: Evaluation of transesophageal echocardiography in detecting cardiac sources of emboli in ischemic stroke patients.
abstract: BACKGROUND
  Embolus is one of the causes of ischemic stroke that can be due to cardiac sources such as valvular heart diseases and atrial fibrillation and atheroma of the aorta. Transesophageal echocardiography (TEE) is superior in identifying potential cardiac sources of emboli. Due to insufficient data on TEE findings in ischemic stroke in Iran, the present study was done to evaluate TEE in detecting cardiac sources of emboli. The main aim of this study was to describe the cardiogenic sources of emboli using TEE in the ischemic stroke patients.
  
  
  METHODS
  This is a cross-sectional study conducted during a 13-month period from January 2012 to February 2013 in Shiraz Nemazee teaching hospital. Patients admitted with stroke diagnosis were included; but hemorrhagic stroke cases were excluded. 229 patients with ischemic stroke diagnosis were included and underwent TEE.
  
  
  RESULTS
  Causes of cardiac emboli were detected in 65 cases (40.7%) and categorized to high-risk (29.7%) and potential risk (11%). High risk cardiac sources included atrial fibrillation (8.7%), mitral valve disease (MS or MI) 11 cases (4.75%), aortic valve disease (AS or AI) 8 (3.5%), prosthetic valve 3 (1.35%), dilated cardiomyopathy 45 (19.65%) and congestive heart failure with ejection fraction < 30% in 8 cases (3.5%). Potential cardiac sources of emboli comprised 7 cases (3.05%) of septal aneurysm, 4 (1.75%) left ventricular hypokinesia, 13 (5.7%) mitral annular calcification and 9 cases (3.95%) complex atheroma in the ascending aorta or proximal arch.
  
  
  CONCLUSIONS
  Our study showed that high risk cardiac sources of emboli can be detected using TEE in a considerable percentage of ischemic stroke patients. The most common high risk cardiac etiologies were dilated cardiomyopathy and valvular heart diseases.
authors.affiliation: MD, Medical student, Student Research Committee, Shiraz University of Medical Sciences, Shiraz Iran. toodeji@sums.ac.ir.
authors.forename: Mohammad Amin
authors.initials: MA
authors.lastname: Toodeji
authors.affiliation: MD, Assistant professor of neurology, clinical neurology Research Center, Neuroscience Research Center, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran. izadisad@sums.ac.ir.
authors.forename: Sadegh
authors.initials: S
authors.lastname: Izadi
authors.affiliation: MD, Assistant professor of neurology, clinical neurology Research Center ,Medical School, Shiraz University of Medical Sciences, Shiraz, Iran. shariat123@gmail.com.
authors.forename: Abdolhamid
authors.initials: A
authors.lastname: Shariat
authors.affiliation: MD, Assistant professor of cardiology, Department of cardiology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran. mhnmp@yahoo.com.
authors.forename: Mohamad Hosin
authors.initials: MH
authors.lastname: Nikoo
keywords: Echocardiography; Embolic; Stroke; Transesophageal