THE CONTRIBUTION OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN THE INVESTIGATION OF PATIENTS WITH CEREBROVASCULAR ISCHEMIA

Abstract

Even though the detection of possible embolic sources in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) is the most common clinical indication for investigation with transesophageal echocardiography (TEE), there is increasing skepticism on both the diagnostic value of TEE and the impact of its findings in secondary stroke prevention strategies. Recent data suggest that TEE detects anatomical abnormalities approximately in half of the patients with cryptogenic ischemic stroke (CS). However, the prevalence of heart diseases considered to be etiopathologically related to the occurrence of AIS (intracardiac thrombi and tumors) is rare. Furthermore, diagnostic findings from TEE in patients with CS or TIA seem to vary widely between studies, as TEE is an operator-dependent diagnostic test and thus existing differences in education and experience of the examiners may be expressed as heterogeneity in the reported findings between studies. Age, but not sex, significantly affects the prevalence of some of these findings, as younger patients have an increased prevalence of atrial septal abnormalities (patent foramen ovale and/or atrial septal aneurysm), while elderly patients present more frequently atherosclerotic lesions in the ascending aorta and/or aortic arch. Also, it appears that TEE examination may have a decisive impact on secondary stroke prevention in patients with CS or TIA. Consequently, it is recommended that all patients with CS or TIA should be referred to TEE examination, regardless of their gender or age.