Transesophageal echocardiogram in the evaluation of acute ischemic stroke of young adults

Abstract

INTRODUCTION: Acute ischemic stroke (AIS) in the young age (≤50 years) is a major cause of disability. The underlying mechanism of AIS in this age group is usually different from elderly. Transthoracic echocardiography (TTE) is used to detect the potential cardiac sources of embolism in AIS patients. Transthoracic echocardiogram (TEE) is superior to detect specific underlying cardio-aortic source of embolism when compared to TTE. We aim to evaluate the diagnostic yield and therapeutic impact of TEE in AIS of young adults. METHODS: We retrospectively reviewed the consecutive patients with AIS in our comprehensive center in a 5-year period from our prospectively collected registry. We selected patients with age ≤50 years who had acute infarcts on brain magnetic resonance imaging or head computed tomography and underwent TEE as part of their diagnostic workup. Demographic details including, age, gender, body mass index, cardiovascular risk factors profile, and TEE findings were collected. RESULTS: Among a total 7,930 patients, 876 (11.04%) were found to be ≤50 years old. Among those, TEE was done in 113 patients (12.8%) in addition to TTE. Those who underwent TEE had a mean age of 40.4 ± 7.9 years, 60 were male (53%), 7 (6.2%) had a history of coronary artery disease, 38 (33%) had a history of diabetes, and 45 (40%) had a history of smoking. TEE showed new abnormal findings in a total of 15 patients (13.2%) that were not reported in their TTEs. Out of these, left atrial appendage thrombus was found in 5, infective endocarditis in 4, atrial septal aneurysms associated with patent foramen ovale (PFO) in 3, and spontaneous mobile echo density in three patients. Overall, new findings from TEE resulted in change in the secondary stroke prevention strategy in 14 patients of those who underwent TEE (12.3%). TEE also confirmed the presence of PFO, which was present on TTE with bubble study in 20 (17.6%) patients. CONCLUSION: TEE may provide additional information in the evaluation of the AIS in young adults, which could lead to change of the secondary stroke prevention strategy.

The diagnostic tests and functional outcomes of acute ischemic stroke or transient ischemic attack in young adults: A 4-year hospital-based observational study

“…Although TEE has 60% positive test results for patients who were evaluated cardiac sources of stroke or emboli, it was only carried out in 4% of patients in our cohort and might not be an inference to its higher diagnostic yields when compared with other cardiac assessments. This could be explained by the fact that TTE is typically followed by TEE to offer a comprehensive evaluation of abnormal cardiogenic morphology [ 15 , 16 ]. These noninvasive diagnostic procedures, however, are probably recommended for young individuals due to increasing the detection of vascular dissection and cardiac sources of stroke, especially PFO with or without ASA, which are the common causes of stroke among young adult patients.…”

“…The odds ratio (OR) and corresponding 95% confidence interval (CI) were used to evaluate conventional risk factors and ischemic stroke subtypes, and statistical significance was indicated when a twosided P value was less than 0.05. All statistical analyses were performed using licensed Stata statistical software version 16…”