This Article Full Text Full Text (PDF) All Versions of this Article: 37/1/204    most recent 01.STR.0000196939.12313.16v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ward, R. P. Articles by Lang, R. M. Search for Related Content PubMed PubMed Citation Articles by Ward, R. P. Articles by Lang, R. M. Related Collections Echocardiography Acute Cerebral Infarction

(Stroke. 2006;37:204.)
© 2006 American Heart Association, Inc.

Original Contributions

Predictors of Long-Term Mortality in Patients With Ischemic Stroke Referred for Transesophageal Echocardiography

From the Noninvasive Imaging Laboratories, Section of Cardiology, Department of Medicine, Chicago, Ill.

Correspondence to R. Parker Ward, MD, Assistant Professor of Medicine, University of Chicago Medical Center, 5841 S Maryland Ave, MC6080, Chicago, IL 60637. E-mail pward{at}medicine.bsd.uchicago.edu

Background and Purpose— Findings on transesophageal echocardiography (TEE) after ischemic stroke predict recurrent embolic events and prompt therapy; however, the additive predictive power of TEE findings on long-term mortality is unknown. Our goal was to study the impact of TEE findings on all cause mortality in ischemic stroke patients referred for TEE.

Methods— We reviewed 245 consecutive patients who underwent TEE for ischemic stroke of undetermined origin (2000 to 2003). Long-term survival was assessed using the Social Security Death Index.

Results— In a mean follow-up period of 3.0 (1.4 to 4.8) years, death occurred in 19.2% of patients. TEE findings included patent foramen ovale (18.8%), left atrium/left ventricle thrombus (2.4%), spontaneous echo contrast (3.7%), atrial septal aneurysm (3.3%), valve vegetation/mass/tumor (7.8%), complex aortic atheroma ([CAA]; 14.7%), and the composite of any cardiac source of embolus (39.2%). A total atherosclerotic burden (TAB) score was also recorded. On Cox hazard regression analysis, measures of aortic atherosclerosis (CAA [hazard ratio (HR), 2.7; 95% CI, 1.4 to 5.3] or TAB score [HR, 1.4; 95% CI, 1.2 to 1.6]) were independent predictors of death, whereas other TEE findings were not.

Conclusion— In patients with ischemic stroke of undetermined origin referred for TEE, measures of aortic atherosclerosis, including CAA, represent the only TEE findings that predict long-term mortality after all other clinical factors are considered. Further study is needed to determine whether treatments for CAA effect long-term survival in patients with ischemic stroke.

Key Words: atherosclerosis • echocardiography, transesophageal • stroke

This article has been cited by other articles:

				J. Roquer, A. Ois, A. Rodriguez-Campello, M. Gomis, E. Munteis, J. Jimenez-Conde, E. Cuadrado-Godia, and J. E. Martinez-Rodriguez Atherosclerotic Burden and Early Mortality in Acute Ischemic Stroke Arch Neurol, May 1, 2007; 64(5): 699 - 704. [Abstract] [Full Text] [PDF]