Stroke, Vol 22, 727-733, Copyright © 1991 by American Heart Association
B Cujec, P Polasek, C Voll and A Shuaib
To compare the diagnostic yields of transesophageal and transthoracic
echocardiography in the detection of potential cardiac sources of embolism,
63 patients (mean +/- SD age 63 +/- 15 [range 18-87] years) with transient
ischemic attacks or stroke underwent both procedures. Transthoracic
echocardiography revealed a potential cardiac source of embolism in 14%
(nine) of the patients, all of whom had clinical evidence of heart disease.
Transesophageal echocardiography revealed a potential cardiac source of
embolism in 41% (26) of the patients; 27% (seven) of these patients had no
clinical cardiovascular abnormalities. Abnormalities detected only by
transesophageal echocardiography in the patients with unsuspected cardiac
disease included atrial septal aneurysm in two, patent foramen ovale in
two, left atrial appendage thrombus in one, and myxomatous mitral valve in
two. The 26 patients with an identified cardiac source of embolism were
older (67.5 versus 59.4 years, p = 0.04), more frequently in atrial
fibrillation (62% [16] versus 8% [3], p less than 0.0001), had a larger
left atrium (43 versus 37 mm, p = 0.01) and more commonly had left
ventricular hypertrophy (62% [16] versus 32% [12], p less than 0.02) than
the 37 patients in whom no cardiac source of embolism was identified. Thus,
transesophageal echocardiography is more sensitive than transthoracic
echocardiography in the detection of potential cardiac sources of embolism
in patients with cerebral ischemic events.
ARTICLES
Transesophageal echocardiography in the detection of potential cardiac source of embolism in stroke patients
Echocardiography Laboratory, University Hospital, Saskatoon, Canada.
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