Selection of Patients for Transesophageal Echocardiography After Stroke and Systemic Embolic Events

Leung, Dominic Y.; Black, Ian W.; Cranney, G.; Walsh, Warren F.; Grimm, Richard A.; Stewart, William J.; Thomas, James D.

doi:10.1161/01.str.26.10.1820

Cited by 95 publications

(79 citation statements)

References 34 publications

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“…In 2034 older patients, the prevalence of occult mitral stenosis is also similar with a pooled estimate of 2% [8,[12][13][14][15][19][20][21][22] and range of 0-5.5%.…”

Section: Mitral Stenosissupporting

confidence: 70%

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Role of routine transthoracic echocardiography in evaluation and management of stroke

Beattie

Cohen

Manning³

et al. 1998

Journal of Internal Medicine

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Objective. To determine the value of routine transthoracic echocardiography in patients with cerebral ischemia without known cardiac disease. Design. The literature from 1990 to 1995 was searched and relevant bibliographies from these papers reviewed. Articles reporting the prevalence and/or risk of stroke for myxoma, vegetation, mitral stenosis, left atrial thrombus, left ventricular thrombus or cardiomyopathy, patent foramen ovale, and atrial septal aneurysm were used. Prevalences and recurrent stroke risk were examined for adult patients less than and greater than 45 years.Results. Both the prevalence of transthoracic echocardiographic findings and recurrent risk of stroke differ by age. The finding of a patent foramen ovale can be expected in nearly half of younger patients with stroke, whilst transthoracic echo can be expected to yield no relevant lesion in three quarters of patients > 45 years. Warfarin anticoagulation appears beneficial in patients with mitral stenosis, left atrial thrombus, left ventricular thrombus, and left ventricular dysfunction, but is of unproven benefit for patent foramen ovale, atrial septal aneurysm, or in the absence of a risk-associated abnormality. Conclusion. For most transthoracic echo findings in stroke, optimal management strategies have not been well defined. Future research is needed to evaluate the appropriate therapeutic approaches.

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“…In 2034 older patients, the prevalence of occult mitral stenosis is also similar with a pooled estimate of 2% [8,[12][13][14][15][19][20][21][22] and range of 0-5.5%.…”

Section: Mitral Stenosissupporting

confidence: 70%

“…The pooled estimate is 0.7%. The prevalence in older patients was examined in seven studies totaling 2892 patients [12][13][14][15][16][17][18][19]. There were only two myxomas, giving a pooled estimate of 0.1%.…”

Section: Echo Findingsmentioning

confidence: 99%

Role of routine transthoracic echocardiography in evaluation and management of stroke

Beattie

Cohen

Manning³

et al. 1998

Journal of Internal Medicine

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“…6 Leung et al 7 recommended TEE for patients with abnormal TTE and for younger patients when finding of patent foramen ovale (PFO) may contribute to patient management. Warner et al 8 pointed out that routine TEE is not cost-effective; patients with atrial fibrillation would receive OA anyway, and those in sinus rhythm would usually have findings for which only aspirin is indicated.…”

mentioning

confidence: 99%

Therapeutic Strategies After Examination by Transesophageal Echocardiography in 503 Patients With Ischemic Stroke

Harloff

Handke

Reinhard

et al. 2006

Stroke

127

109

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“…Image quality of TTE has improved over the years and there are conflicting data about the additional therapeutic benefit of TEE. [7][8][9][10][11][12][13][14] We evaluated the additional value of TEE in the determination of a potential CES requiring treatment other then the standard dose of antiplatelet therapy in patients less than 50 years of age with a TIA or stroke. We also investigated the recurrence rate of TIA or ischaemic stroke during follow-up in patients in whom treatment was changed because of the TEE.…”

mentioning

confidence: 99%

Influence of transoesophageal echocardiography on therapy and prognosis in young patients with TIA or ischaemic stroke

Rettig¹,

Bouma²,

Brink³

2009

NHJL

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Objective. To determine the influence of transoesophageal echocardiography (TEE) on therapy and prognosis in patients with cryptogenic transient ischaemic attack (TIA) or ischaemic stroke under the age of 50 years. Methods and results. We evaluated all patients aged 50 and under who were referred to our university hospital for cryptogenic TIA or ischaemic stroke during the period 1 January 1996 to 31 December 2004. All patients underwent both transthoracic echocardiography (TTE) and TEE. Patients with known pre-existent heart disease, such as atrial fibrillation, were excluded. Eighty-three patients with TIA (22) and ischaemic stroke (61) were enrolled. Mean age was 39±8 years (range 18 to 50). In 30% of the patients TEE detected one or more potential cardioembolic source, compared with 10% for TTE (p=0.003). Standard treatment (aspirin 38 mg daily) was changed in 7% of the patients due to the TEE findings. Complete followup was obtained in 93% with an average of 5±3 years. Twelve recurrences occurred; two out of six patients (33%) with therapy change and ten out of 71 (14%) of the patients without therapy change had a recurrent TIA or ischaemic stroke. Conclusion. In patients with cryptogenic TIA or ischaemic stroke, TEE is superior to TTE in the detection of a potential cardiac source of embolism.

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Selection of Patients for Transesophageal Echocardiography After Stroke and Systemic Embolic Events

Cited by 95 publications

References 34 publications

Role of routine transthoracic echocardiography in evaluation and management of stroke

Role of routine transthoracic echocardiography in evaluation and management of stroke

Therapeutic Strategies After Examination by Transesophageal Echocardiography in 503 Patients With Ischemic Stroke

Influence of transoesophageal echocardiography on therapy and prognosis in young patients with TIA or ischaemic stroke

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