Transesophageal echocardiography in patients with cryptogenic cerebral ischemia

Knebel, Fabian; Masuhr, Florian; Hausen, Wolfram von; Walde, Torsten; Dreger, Henryk; Raab, V; Yuerek, Mahsun; Baumann, Gert; Borges, Adrian C.

doi:10.1186/1476-7120-7-15

Cited by 36 publications

(19 citation statements)

References 30 publications

(31 reference statements)

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“…It is noteworthy that LVDD is well established as a risk factor for incident AF. 9,13,[25][26][27][28] Many clinicians had assumed that LVDD is a physiological mechanism for how certain risk factors, such as hypertension, contribute to the development of AF. 13 AF may be related to the increased incidence of LVDD-related coexisting pathological changes in the myocardium and atrial tissue.…”

Section: Discussionmentioning

confidence: 99%

Implication of Left Ventricular Diastolic Dysfunction in Cryptogenic Ischemic Stroke

Seo

Lee

et al. 2014

Stroke

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Background and Purpose— Left ventricular diastolic dysfunction (LVDD) is a predictor for atrial fibrillation (AF). This study was aimed to investigate whether LVDD in cryptogenic ischemic stroke (CS) could be a clue to stroke mechanism. Methods— The clinical and echocardiographic findings of 1589 consecutive patients with acute ischemic stroke or transient ischemic attack between 2004 and 2013 were reviewed. LVDDs among stroke subtypes were graded by transthoracic echocardiography into 4 groups by severity: normal, abnormal relaxation (grade I), pseudonormal (grade II), and restrictive diastolic filling (grade III), whereas severe LVDD was defined as grade III. We classified the lesion pattern of CS into cardioembolism-mimic or non–cardioembolism-mimic and determined whether cardioembolism-mimic lesions were associated with severe LVDD. Results— The fraction of severe LVDD in CS was not different from that of stroke with AF (27.3% versus 37.1%; P =0.173) but was significantly higher than that of stroke without AF (27.3% versus 13.4%; P =0.008). Cardioembolism-mimic CS had more severe LVDD than non–cardioembolism-mimic CS (41.4% versus 11.5%; P =0.013). LVDD of grade II (odds ratio, 4.37; 95% confidence interval, 2.99–6.41) and grade III (odds ratio, 5.60; 95% confidence interval, 3.42–9.17) were independently related to stroke with AF after adjusting covariates. Conclusions— The severe LVDD could be a predictor of stroke with AF, and its frequency was similar between CS and stroke with AF. Cardioembolism-mimic CS had significantly more severe LVDD than non–cardioembolism-mimic CS. LVDD could be helpful to discriminate the stroke mechanism in the patients with acute CS.

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Section: Discussionmentioning

confidence: 99%

Implication of Left Ventricular Diastolic Dysfunction in Cryptogenic Ischemic Stroke

Seo

Lee

et al. 2014

Stroke

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“…15 In another study, TEE identified a cardiac source in about 50% of patients when the basic evaluation including TTE failed to identify a source. In this study, a PFO was the most often detected potential cardiac source, followed by valvular abnormalities and aortic plaques.…”

Section: Cardiac Testingmentioning

confidence: 97%

“…18 Left atrial or left ventricular thrombus is identified in 1%-16% of patients with cryptogenic stroke, with TEE being more sensitive than TTE. 14,15 When found, this should prompt consideration of anticoagulation. Furthermore, when endocarditis is clinically suspected, TEE is more sensitive than TTE in identifying valvular vegetations, suggesting the need for IV antibiotics.…”

Section: Cardiac Testingmentioning

confidence: 99%

Cryptogenic stroke

Yaghi

Elkind

2014

Neur Clin Pract

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SummaryCryptogenic, or unexplained, stroke is present in about 30%-40% of ischemic stroke patients. Pursuing a stroke mechanism is important in such patients to better choose therapy to reduce the stroke recurrence risk. Intracranial vessel imaging and cardiac evaluation with transesophageal echocardiogram and outpatient cardiac monitoring may help identify the stroke mechanism. This article highlights the diagnostic yield of various tests in identifying a stroke mechanism in stroke patients whose initial diagnostic evaluation is negative, and the implications for treatment.A 57-year-old man with an unremarkable medical history presented to the emergency room 5 days after the acute onset of left arm and hand weakness and numbness. He denied other neurologic symptoms. Blood pressure was 160/78 mm Hg and heart rate 78 and regular. General physical examination results were normal. He had mild dysarthria. Mental status and cranial nerve examination results were otherwise normal. He had mild weakness and reduced dexterity in the left hand, but cerebellar and sensory examinations, including graphesthesia and stereognosis, had normal results. ECG showed normal sinus rhythm. MRI showed a small cortical infarct in the right precentral gyrus (figure 1). Magnetic resonance angiography showed no major carotid or intracranial arterial stenosis. Inpatient telemetry did not show atrial fibrillation. Transthoracic echocardiography with agitated saline contrast suggested an intracardiac shunt, and transesophageal echocardiography confirmed the diagnosis of a patent foramen ovale (PFO) associated with an atrial septal aneurysm. A subsequent 21-day outpatient cardiac monitor did not show evidence of atrial fibrillation. He was treated with antiplatelet and statin therapy and referred for evaluation for participation in a randomized trial of interventional closure for PFO. BACKGROUNDIdentifying the stroke mechanism is a crucial aspect of secondary prevention of ischemic stroke. However, no stroke etiology is identified in 30%-40% of patients.1,2 Cryptogenic stroke is the term used to refer to strokes for which no definite cause can be identified.

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“…(16) TEE is thus recommended for all patients with cryptogenic stroke to identify PFO or other cardiac causes. (14,15) results oF trAnscAtheter closure In…”

Section: Pfo and Strokementioning

confidence: 99%

“…In patients with cryptogenic stroke, it is recommended that TEE should routinely be included in the assessment of such patients since it also allows other cardiovascular causes of stroke to be detected. (13)(14)(15) FIGure 2: tEE images of Pfo. In A, a long tunnel-like Pfo is demonstrated with a thin septum secundum overlapping (arrow) a thick septum secundum.…”

mentioning

confidence: 99%

Percutaneous closure of the patent foramen ovale: A cardiological perspective

Brown

2017

SAHJ

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Transesophageal echocardiography in patients with cryptogenic cerebral ischemia

Cited by 36 publications

References 30 publications

Implication of Left Ventricular Diastolic Dysfunction in Cryptogenic Ischemic Stroke

Implication of Left Ventricular Diastolic Dysfunction in Cryptogenic Ischemic Stroke

Cryptogenic stroke

Percutaneous closure of the patent foramen ovale: A cardiological perspective

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