Transesophageal Echocardiographic Findings in Stroke Subtypes

ABSTRACT

Although transesophageal echocardiography (TEE) is known to be useful in detecting a possible embolic source in patients with ischemic stroke, its usefulness in various stroke subtypes remains still uncertain. We reviewed the clinical findings and TEE records of 191 patients with various stroke subtypes. We classified them into four stroke subtypes- cardiac embolism, lacunar infarct, large artery disease and stroke of unclear etiology. TEE parameters such as left atrial thrombus, spontaneous echo contrast, atrial septal aneurysm, interatrial shunts, ventricular thrombus or aneurysm, myxomatous mitral valve or mitral valve prolapse and atheromatous plaque on ascending aorta or aortic arch were compared among different stroke subtypes. The yield of TEE was subtantial in all stroke subtypes. Left atrial thrombi and spontaneous echo contrast were frequent in patients with high-risk cardiac embolism-21.4% and 42.9%, respectively, whereas only one patient had spontaneous echo contrast in other subtypes. Interatrial shunt was common in all stroke subtypes and was found more frequently in stroke of unclear etiology (42. 9%) compared to other subtypes (27. 2%) (P=O.02, X2). Other parameters were detected in only a few patients. TEE seems to be a useful procedure in patients with high-risk cardiac embolism, and the clinical significance of interatrial shunt in patients with stroke of unclear etiology remains to be determined.