marmara med j

Marmara Medical Journal

1019-1941 1309-9469

Marmara University

EVALUATION OF TRANSTHORACIC AND TRANSESOPHAGEAL ECHOCARDIOGRAPHIC FINDINGS IN ACUTE ISCHEMIC STROKE

Tuncer

Neşe

Afşar

Nazire

Dağdeviren

Bahadır

Özergin

Ayşe

Aktan

Sevinç

12 03 2016

14 1 16 22 03 22 2016

1988

Marmara Medical Journal

Objective: Approximately 20% of all Ischemicstrokes are the result of an embolus originatingfrom the heart. Transthoracic echocardiography(TTE) has long been used to evaluate the cardiacsource of emboli but recently transesophagealechocardiography (TEE), which has higher yieldfor detecting left atrium, aortic arch and left atrialappendage lesions, Is recommended for theassessment of patients with clinical risk factorsfor cardioembolism or unexplained stroke.Methods: In this study, the diagnostic yield ofTTE and TEE for detecting potential cardiacsources of the embolus was compared in 46consecutive patients (26 men and 20 women,aged 23-84 years) with transient ischemic attack(TIA) or acute ischemic stroke.Results: TTE revealed a potential cardiacsource of embolism in 12 (26%) patients, all ofwhom had clinical evidence of heart disease,TEE detected potential cardiac sources ofembolism in 32 (69%) patients; 7 (21%) of thesehad no clinical evidence of heart disease.Conclusion: TEE is a superior technique to TTEfor identifying potential cardiac source of theembolus and should be recommended for earlymanagement and prevention of further stroke inpatients with underlying heart disease orunexplained cerebrovascular accident.Key Words: Ischemic stroke, Transthoracicechocardiography, Transesophagealechocardiography, Cardiac source of embolism.

Bogousslavsky J, Welle GV, Kcgli T. The Lausanne Stroke Study; analysis of 1000 consecutive patients with first stroke. Stroke 1988; 19:1083-1092.

Cerebral Embolism Task Force. Cardiogenic brain embolism. Arch rieurol 1989:46:727- 743.

Mohr JP, Caplan LR, Melski JW, et al. The Harvard Cooperative Stroke Registry: A prospective registry, neurology 1978:28:754- 762.

Bogousslavsky J, Cachin C, Regli P, et al. Cardiac sources of embolism and cerebral infarction - clinical consequences and vascular concomitants: The Lausanne Stroke Registry, neurology 1991 ;41 -.855-859.

Biller J, Johnson MR, Adams HP, et at. Echocardiologic evaluation of young adults with nonhemorrhagic cerebral infarction. Stroke 1986; I 7:608-612.

Pop G, Sutherland GR, Koudstaal PJ, et al. Transesophageal echocardiography in the detection of intracardiac embolic sources in patients with transient ischemic attacks. Stroke 1990;2 1:560-565.

Rauh G, Pischereder M, Spengel PA. Transesophageal echocardiography in patients with focal cerebral ischemia of unknown cause. Stroke 1996;27:691-694.

Tegeler CH, Downes TR. Cardiac imaging in stroke. Stroke 1991;26:13-18.

Hart RG. Cardiogenic brain embolism to the brain. Lancet 1992;339:589-594.

Leung DY, Black 1W, Cranney GB, et al. Selection of patients for transesophageal echocardiography after stroke and systemic

embolic events. Role of transthoracic echocardiography. Stroke 1995:26:1820- 1824.

Hofmann T, Kasper W, Meinetrz T, et al. Echocardiographie evaluation of patients with clinically suspected arterial emboli. Lancet 1990:336:1421-1424.

Asinger RW, Herzog CA, Dick CD. Echocardiography in the evaluation of cardiac sources of emboli. Echocardiography 1993,10:373-396.

Pearson AC. Transthoracic echocardiography versus transesophageal echocardiography in detecting cardiac sources of embolism. Echocardiography 1993; 10:397-402.

Shyu K, Chen J, Huang Z, et al. Role of transesophageal echocardiography in the diagnostic assessment of cardiac sources of embolism in patients with acute ischemic stroke. Cardiology 1994:85:53-60.

Labovitz A. The increasing role of

transesophageal echocardiography in unexplained cerebral ischemia.

Echocardiography 1993; 10:363-365.

DeRook PA, Comess KA, Albers GW, et al. Transesophageal echocardiography in the evaluation of stroke. Ann Int Med 1992; 117:922-932.

Autore C, Cartoni D, Piccininno M. Multiplane transesophageal echocardiography and stroke. AM J Cardiol 1998;81 (12A): 79G-81G.

Albers GW, Comess KA, DeRook PA, et al. Transesophageal échocardiographie findings instroke subtypes. Stroke 1994;25:23-28.

Siostrzonek P, Zangeneh M, Gôssinger H, et al. Comparison of transesophageal and transthoracic contrast echocardiography for detection of a patent foramen ovale. Am J Cardiol 1991;68:1247-1249.

Amerenco P, Duyckaerts C, Tzourlo C, et al. The prevalence of ulcerated plaques in the aortic arch in patients with stroke. Ti Engl J Med 1992;326:221-225.

Agmon Y, Khandheria BK, Meissner I, et al. Frequency of atrial septal aneurysms in patients with cerebral ischemic events. Circulation 1999:99:1942-1944.

Seward J, Khandheria BK, Oh JK, et al.

Transesophageal echocardiography:

technique, anatomic correlations,

implementation and clinical application. Mayo Clin Proc 1988;63:649-680.

Cabin HS, Clubb KS, Hall C, et al. Risk for systemic embolization of atrial fibrillation

Ne$e Tuncer, et at

without mitral stenosis.Am J Cardiol 1990;65:11 12-1 116.

Briley DP, Giraud GD, Beamer HB, et ai. Spontaneous echocontrast and hemorheologic abnormalities in cerebrovascular disease. Stroke 1994;25:1564-1569.

Black IW, Hopkins AP, Lee LC, et al. Left atrial spontaneous echocontrast: a clinical and échocardiographie analysis. J Am Coll Cardiol 1991;18:398-404.

Chimowitz Ml, DeGeorgia MA, Poole RM, et al. Left atriaI spontaneous echocontrast is highly associated with previous stroke in patients with atrial fibrillation or mitral stenosis. Stroke 1993;24:1015-1019.

Leung DY, Black IW, Cranney GB, et al. Prognostic implications of left atrial spontaneous echocontrast in nonvalvular atrial fibrillation. J Am Coll Cardiol 1994;24:755-762.

Poulkes MA, Wolf PA, Price TR, et al. The

stroke data bank: Design, methods and baseland characteristics. Stroke

;19:547-554.

Gomez CR, Tulyapronchote R. neurologists' perspective in the evaluation of ischemic stroke. Echocardiography 1993;10:367-372.

Lynch JJ. Prevalence of right to left atrial

shunting in a healthy population: Detection by Valsalva maneuver contrast

echocardiography. Am J Cardiol 1984;53:1478-1480.

Pearson AC, Hagelhout D, Castello R, et at.

Atrial septal aneurysm and stroke: a

transesophageal échocardiographie study. J Am Coll Cardiol 1991,18:1223-1229.

Amerenco P, Cohen A, Tzourio C, et al. Atherosclerotic disease of the aortic arch and the risk of ischemic stroke. H Engl J Med 1994;331:1474-1479.

Cohen A, Tzourio C, ChauveI C, et al. Mitral valve strands and the risk of ischemic stroke in elderly patients. Stroke 1997;28:1574- 1578.

Roberts JR, Omarali I, Tullio MR, et al. Valvular strands and cerebral ischemia. Stroke 1997;28:2185-2188.

Cujec B, Plasek P, Voll C et al. Transesophageal echocardiography in the detection of potential cardiac source of embolism in stroke patients. Stroke 1991;22:727-733.