Therapeutic implications of transesophageal echocardiography after transthoracic echocardiography on acute stroke patients

Abreu, Tiago

doi:10.2147/vhrm.s2175

Cited by 12 publications

(3 citation statements)

References 18 publications

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“…Several studies demonstrated that TEE is superior to TTE for identification of a cardiac embolic source in patients with TIA or stroke (11,12). De Brujn et al (11), in patients with acute stroke, found a thrombus in 17% of the patients using TEE compared to 2% using TTE.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of trans-thoracic echocardiography in patients with acute stroke and atrial fibrillation: findings from the RAF study

et al. 2015

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Paciaroni, M. et al. (2016) Prognostic value of trans-thoracic echocardiography in patients with acute stroke and atrial fibrillation: findings from the RAF study. Journal of Neurology, 263(2), pp. 231-237. (doi:10.1007/s00415-015-7957-3) There may be differences between this version and the published version. You are advised to consult the publisher's version if you wish to cite from it.http://eprints.gla.ac.uk/117439/ UO Gravi Cerebrolesioni, San Giovanni Battista Hospital, Foligno. These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. 23 Stroke Unit, Department of Neurology, Sant'Andrea Hospital, La Spezia, Italy. These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. 24 Department of Internal Medicine, Insubria University, Varese, Italy. These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. 25 Stroke Unit, Neurology, Insubria University, Varese, Italy. These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. 26 Stroke Unit, Ospedale di Portogruaro, Portogruaro (Venice), Italy. These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. 27 Department of Neurology, University of L'Aquila, Italy. These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. 28 Department of Internal Medicine, Ospedale Civile di Piacenza, Italy. These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. 29 Municipal Budgetary Healthcare Institution of Novosibirsk. City Clinical Hospital #1. Novosibirsk (Russia) 30 Stroke Unit, Jazzolino Hospital, Vibo Valentia, Italy. These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. 31 Department of Neurology and Psychiatry, Sapienza University of Rome, Italy. These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. 32 Stroke Unit, Ospedale Civico, Palermo. These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. The Authors report that no funding has been received for this study. 4Abstract Background and purposes: Anticoagulant therapy is recommended for the secondary

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Section: Discussionmentioning

confidence: 99%

Prognostic value of trans-thoracic echocardiography in patients with acute stroke and atrial fibrillation: findings from the RAF study

et al. 2015

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“…Some clinicians prefer to perform TTE first, and if positive for cardioembolic stroke proceed with treatment, depending on the cause. However, if TTE is negative and TEE is not obtained, it is possible to fail to identify the source of cardiac embolism [15,16]. The risks of TEE include local irritation or injury to the oropharynx and esophagus; respiratory decompensation, especially in those with poor cardiopulmonary status (e.g., end-stage cardiopulmonary disease); increasing intracranial pressure, in patients who are at risk.…”

Section: Evaluation Of Patients At Risk For Cardioembolic Strokementioning

confidence: 99%

Prevention of Cardioembolic Stroke

Freeman

Aguilar

2011

Neurotherapeutics

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Cardiac causes of ischemic stroke lead to severe neurological deficits from large intracranial artery occlusion compared to small vessel ischemic stroke. The most common cause of cardioembolic stroke is atrial fibrillation (AF), which has an increasing incidence with age. AF stroke trials demonstrate that anti-coagulation is superior to anti-platelet therapy in terms of ischemic stroke prevention. Recently, warfarin was compared with dabigatran, an oral, direct thrombin inhibitor, and was found to be at least equally effective in reducing ischemic stroke with less intracranial bleeding risk. Future research is investigating other direct thrombin inhibitors as potential alternatives to warfarin, which has a narrow therapeutic index, requires frequent blood monitoring, has multiple drug interactions, and a higher rate of intracranial bleeding. Other causes of cardioembolic stroke include myocardial infarction, left ventricular thrombus, reduced ejection fraction, valvular abnormalities, and endocarditis. Patent foramen ovale is a common finding on echocardiograms in patients with and without stroke (up to 20% of the population), and it is a controversial source of cryptogenic stroke. The best way to prevent cardioembolic stroke remains early detection and treatment of AF, and treating the underlying stroke mechanism. Cardiac magnetic resonance imaging is an emerging technology and reveals some sources of cardiac embolism missed by echocardiography, and might provide an additional diagnostic tool in investigating cardioembolic stroke.

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“…But even after comprehensive diagnostics, stroke etiology remains cryptogenic in 22-43% of patients (1)(2)(3). In such cases, transesophageal echocardiography (TEE) can be helpful to detect further cardiac or aortic sources of brain embolism (4)(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Bubble Test and Carotid Ultrasound to Guide Indication of Transesophageal Echocardiography in Young Patients With Stroke

et al. 2022

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Background and PurposeIndication of transesophageal echocardiography (TEE) in patients ≤60 years with brain ischemia is uncertain.MethodsThis prospective double-blinded study included patients with cryptogenic acute ischemic stroke or transient ischemic attack (TIA) ≥18 and ≤60 years. After routine diagnostics, all patients underwent patent foramen ovale (PFO) screening by transcranial Doppler (TCD) bubble test, carotid ultrasound for atherosclerosis screening (intima-media-thickness >0.90 mm or plaques), and TEE. We calculated sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) of the combined non-invasive ultrasound to predict therapy-relevant TEE findings.ResultsWe included 240 consecutive patients (median 51 years, 39% women) of which 68 (28.3%) had both a negative bubble test and no carotid atherosclerosis. Of these, 66 (97.1%) had unremarkable TEE findings; in one patient a small PFO was found and closed subsequently, in another patient a 4.9 mm thick aortic atheroma was found, and double platelet inhibition initiated. Of the other 172 (71.7%) patients, 93 (54%) had PFO and 9 (5.2%) complex aortic plaques. No other therapy-relevant findings were present in both groups. Non-invasive ultrasound had a sensitivity of 98.0%, specificity of 47.8%, NPV of 97.1%, and PPV of 58.1% for therapy-relevant TEE findings.ConclusionsBubble test and carotid ultrasound could be used for the individual decision for/against TEE in patients with cryptogenic stroke ≤60 years. If they are unremarkable, TEE can be omitted with high safety regarding secondary prevention. If bubble test is positive and/or carotid ultrasound shows atherosclerosis, TEE should be carried out if PFO or aortic atheroma are potentially relevant for further patient management.

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Therapeutic implications of transesophageal echocardiography after transthoracic echocardiography on acute stroke patients

Cited by 12 publications

References 18 publications

Prognostic value of trans-thoracic echocardiography in patients with acute stroke and atrial fibrillation: findings from the RAF study

Prognostic value of trans-thoracic echocardiography in patients with acute stroke and atrial fibrillation: findings from the RAF study

Prevention of Cardioembolic Stroke

Bubble Test and Carotid Ultrasound to Guide Indication of Transesophageal Echocardiography in Young Patients With Stroke

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