Transesophageal echocardiography in patients with cryptogenic ischemic stroke: A systematic review

McGrath, Emer R.; Paikin, Jeremy S.; Motlagh, Bahareh; Salehian, Omid; Kapral, Moira K.; O’Donnell, Martin

doi:10.1016/j.ahj.2014.07.025

Cited by 53 publications

(50 citation statements)

References 51 publications

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“…A first episode of AF was detected after enrollment but during the in-hospital stay (median 5 days [IQR, [4][5][6], range 1-17 days) in 5 (4.9%) study patients. cvMRI or echocardiography revealed left atrial enlargement in 3 of these patients.…”

Section: Detection Of Embolic Sources By Cvmri Versus Echocardiographymentioning

confidence: 99%

“…5 Despite interstudy variations on the definition and prevalence of (potential) embolic sources, current guidelines recommend diagnostic echocardiography in stroke patients. 2 Although noninvasive transthoracic echocardiography (TTE) is easy to use, semi-invasive transesophageal echocardiography (TEE) is typically needed to visualize the left atrium, left atrial appendage, atrial shunts, and the aortic arch-all of them potential sources of embolism.…”

Section: May 2017mentioning

confidence: 99%

“…Although 1 patient refused to undergo cvMRI after enrollment, 102 (99.0%) of 103 stroke patients underwent cvMRI during the initial in-hospital stay (median length 5 days [IQR, [4][5][6]). In total, 89 (86.4%) patients completed the cvMRI protocol (median duration 50 min [IQR, 42-58.5 min]) in hospital.…”

Section: Feasibility Of Cvmri and Echocardiography In Acute Stroke Pamentioning

confidence: 99%

“…An atrial shunt (patent foramen ovale or atrial septum defect) was detected by echocardiography in 33 (32.2%) of 102 study patients and in 3 of these patients according to contrast-enhanced cvMRI (done in 31 of 33 patients). An atrial shunt was suspected by cvMRI in 2 patients without atrial shunt according to TEE.A first episode of AF was detected after enrollment but during the in-hospital stay (median 5 days [IQR,[4][5][6], range 1-17 days) in 5 (4.9%) study patients. cvMRI or echocardiography revealed left atrial enlargement in 3 of these patients.…”

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confidence: 99%

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Feasibility and Diagnostic Value of Cardiovascular Magnetic Resonance Imaging After Acute Ischemic Stroke of Undetermined Origin

Hæusler

Wollboldt

Bentheim

et al. 2017

Stroke

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E tiologic work-up is essential in patients with acute ischemic stroke to optimize secondary stroke prevention. According to international guidelines, state-of-the-art diagnostic work-up includes brain imaging, ultrasound of brainsupplying arteries, echocardiography, ECG monitoring, and distinct blood tests.1,2 However, stroke etiology remains undetermined (cryptogenic) in about 25% of all acute ischemic stroke patients. 3 Apart from nonpermanent atrial fibrillation (AF), 4 ventricular noncompaction, left atrial or ventricular thrombi, mitral or aortic valve stenosis, and ulcerated aortic arch atherosclerotic plaques are associated with a moderate to high embolic stroke risk and were found in a substantial part Background and Purpose-Etiology of acute ischemic stroke remains undetermined (cryptogenic) in about 25% of patients after state-of-the-art diagnostic work-up. Methods-One-hundred and three patients with magnetic resonance imaging (MRI)-proven acute ischemic stroke of undetermined origin were prospectively enrolled and underwent 3-T cardiac MRI and magnetic resonance angiography of the aortic arch in addition to state-of-the-art diagnostic work-up, including transesophageal echocardiography (TEE). We analyzed the feasibility, diagnostic accuracy, and added value of cardiovascular MRI (cvMRI) compared with TEE for detecting sources of stroke. Despite interstudy variations on the definition and prevalence of (potential) embolic sources, current guidelines recommend diagnostic echocardiography in stroke patients. 2Although noninvasive transthoracic echocardiography (TTE) is easy to use, semi-invasive transesophageal echocardiography (TEE) is typically needed to visualize the left atrium, left atrial appendage, atrial shunts, and the aortic arch-all of them potential sources of embolism.6 Serious complications during TEE rarely occur.7 However, required preprocedural fasting, periprocedural conscious sedation, and the demand of highly skilled personnel limit its availability and cause in-hospital delays. 8 In consequence, TEE is not routinely performed in (cryptogenic) stroke patients, even in high-income countries.9 Subsequently, assessment of potential embolic sources of ischemic stroke is often inappropriate in clinical practice. Although cardiac computed tomography could add information about stroke etiology, 10 the main disadvantage of this approach is the exposure to radiation. Cardiac magnetic resonance imaging (MRI) has been increasingly often implemented in the clinical diagnostic workflow of various cardiac diseases over the past 10 years and allows for accurate biventricular functional analysis and tissue characterization. Cardiac MRI is now considered the gold standard to assess cardiac tumors, myocarditis, cardiomyopathies, and subclinical coronary heart disease. 11,12 In addition, cardiac MRI has demonstrated feasibility of detecting atrial or ventricular thrombi, 13 aortic atherosclerotic plaques, 14,15 or left atrial enlargement. 16,17 Moreover, cardiac MRI is superior to echocardiography on d...

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Section: Detection Of Embolic Sources By Cvmri Versus Echocardiographymentioning

confidence: 99%

Section: May 2017mentioning

confidence: 99%

Section: Feasibility Of Cvmri and Echocardiography In Acute Stroke Pamentioning

confidence: 99%

mentioning

confidence: 99%

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Feasibility and Diagnostic Value of Cardiovascular Magnetic Resonance Imaging After Acute Ischemic Stroke of Undetermined Origin

Hæusler

Wollboldt

Bentheim

et al. 2017

Stroke

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“…The advantage of a TEE is that it provides better views of the left atrium (LA), left atrial appendage (LAA) and aortic arch. In addition, it is superior to TTE in identifying cardiac shunts such as PFO 18. TTE, however, is more widely used, non-invasive and less expensive when compared to TEE.…”

Section: Cardiac Imaging Of Patients With Ischemic Strokementioning

confidence: 99%

Cardiac magnetic resonance imaging: a new tool to identify cardioaortic sources in ischaemic stroke

Yaghi

Liberman

Atalay

et al. 2016

J Neurol Neurosurg Psychiatry

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Stroke of undetermined aetiology or 'cryptogenic' stroke accounts for 30-40% of ischaemic strokes despite extensive diagnostic evaluation. The role and yield of cardiac imaging is controversial. Cardiac MRI (CMR) has been used for cardiac disorders, but its use in cryptogenic stroke is not well established. We reviewed the literature (randomised trials, exploratory comparative studies and case series) on the use of CMR in the diagnostic evaluation of patients with ischaemic stroke. The literature on the use of CMR in the diagnostic evaluation of ischaemic stroke is sparse. However, studies have demonstrated a potential role for CMR in the diagnostic evaluation of patients with cryptogenic stroke to identify potential aetiologies such as cardiac thrombi, cardiac tumours, aortic arch disease and other rare cardiac anomalies. CMR can also provide data on certain functional and structural parameters of the left atrium and the left atrial appendage which have been shown to be associated with ischaemic stroke risk. CMR is a non-invasive modality that can help identify potential mechanisms in cryptogenic stroke and patients who may be targeted for enrolment into clinical trials comparing anticoagulation to antiplatelet therapy in secondary stroke prevention. Prospective studies are needed to compare the value of CMR as compared to transthoracic and transesophageal echocardiography in the diagnostic evaluation of cryptogenic stroke.

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Left atrial appendage thrombus detected by transesophageal examination with linear endoscopic ultrasound

Ikezawa

Shigekawa

Sengoku

et al. 2019

Clinical Case Reports

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Transesophageal echocardiography in patients with cryptogenic ischemic stroke: A systematic review

Cited by 53 publications

References 51 publications

Feasibility and Diagnostic Value of Cardiovascular Magnetic Resonance Imaging After Acute Ischemic Stroke of Undetermined Origin

Feasibility and Diagnostic Value of Cardiovascular Magnetic Resonance Imaging After Acute Ischemic Stroke of Undetermined Origin

Cardiac magnetic resonance imaging: a new tool to identify cardioaortic sources in ischaemic stroke

Left atrial appendage thrombus detected by transesophageal examination with linear endoscopic ultrasound

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