Vnitr Lek 2006, 52(2):144-151

The role of transesophageal echocardiopgraphy in detection of cardiogenic and aortic sources of embolism in stroke and transient ischaemic attacks

J. Dúbrava^1,*, R. Garay²

¹ Oddelenie funkčnej diagnostiky FNsP Bratislava, pracovisko Petržalka, Slovenská republika, prednosta prim. MUDr. Juraj Dúbrava, Ph.D.

² Neštátne neurologické oddelenie, NEURÓN PLUS, s.r.o., Bratislava, Slovenská republika, prednosta prim. MUDr. Róbert Garay, CSc.

Objectives:
To prospectively investigate the prevalence of definite and potential sources of cardiogenic embolism and embolism from ascending aorta and aortic arch in patients with a cryptogenic stroke or transient ischaemic attack (TIA).


Material/methods:
The study group consisted of 218 consecutive patients (146 males, mean age 59.4 ± 11.5, range 38-83 years) without significant stenoses of carotic and vertebral arteries. All patients underwent biplane/multiplane transesophageal echocardiography (TEE). 77.5 % of patients suffered a stroke and 22.5 % had a TIA. Sinus rhythm was in 74.8 % of the patients, atrial fibrillation in 22.0 % and pacemaker rhythm in 3.2 %.

Results:
1. Definite source of embolism was identified in 21.6 % of patients. The most frequent finding was a thrombus of the left atrial (LA) appendage - 12.4 %. Less frequently found were mobile thrombus of aortic arch - 3.7 %, thrombus of LA body - 2.3 %, left ventricular thrombus - 2.3 %, thrombus of valvular prosthesis - 1.4 % and heart tumor - 0.5 %. 2. The total prevalence of potential sources of embolism was 61.5 %. Only potential source (without definite source) was demonstrated in 52.3 % of patients. Very frequently were found patent foramen ovale - 58.3 % and atherosclerosis of ascending aorta or aortic arch - 53.7 %. Further sources were LA spontaneous echocontrast - 21.1 %, reduced function of LA appendage - 18.3 %, atrial septal aneurysm - 7.8 %, atrial septal defect - 1.4 %, cardiac foreign body - 0.5 %. 3. TEE did not reveal any source of embolism in 26.1 % of patients.

Conclusions:
1. 21.6 % of the patients suffering from stroke/TIA without hemodynamically significant stenoses of extracranial cerebral arteries had a definite cardiogenic or aortic source of embolism, 2. additional 52.3 % of patients had only potential source of embolism (without definite source), 3. we consider TEE necessary in patients with stroke/TIA without a known etiology, despite complete neurological examination and transthoracic echocardography.

Keywords: stroke; transient ischaemic attack; cardiogenic embolism; aortic source of embolism; transesophageal echocardiography

Received: September 19, 2005; Accepted: December 6, 2005; Published: February 1, 2006  Show citation