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Transoesophageal echocardiography in patients with acute stroke with sinus rhythm and no cardiac disease history
  1. Hyun-Ji Cho1,2,
  2. Hye-Yeon Choi1,
  3. Young Dae Kim1,
  4. Hyo-Suk Nam1,
  5. Sang Won Han1,3,
  6. Jong Won Ha4,
  7. Nam-Sik Chung4,
  8. Ji Hoe Heo1
  1. 1Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
  2. 2Department of Neurology, Konkuk University College of Medicine, Seoul, Korea
  3. 3Department of Neurology, Sanggye Baik Hospital, Inje University College of Medicine, Seoul, Korea
  4. 4Department of Cardiology, Yonsei University College of Medicine, Seoul, Korea
  1. Correspondence to Professor Ji Hoe Heo, Department of Neurology, Yonsei University College of Medicine, 250 Seongsan-no, Seodaemoon-gu, Seoul 120-752, Korea; jhheo{at}yuhs.ac

Abstract

Background Transoesophageal echocardiography (TOE) is the gold standard for detecting potential cardiac sources of embolism (PCSE). However, the role of TOE in patients with ischaemic stroke with normal sinus rhythm (NSR) and no cardiac disease remains uncertain.

Methods The authors retrospectively analysed 1833 consecutive patients with ischaemic stroke with NSR and no history of cardiac disease who were examined by TOE. The authors investigated the frequency of PCSE and aortic plaques detected in these patients. Determination of high- and medium-risk PCSE was based on the Trial of ORG 10172 in the Acute Stroke Treatment classification. The authors also determined how the proportions of stroke subtypes and treatment strategies based on current guidelines have been changed after TOE.

Results PCSE and/or aortic plaques were detected in 753 (41.1%) of 1833 patients. After TOE, a total of 355 PCSE (45 high-risk PCSE and 310 medium-risk PCSE) were found in 323 patients (17.6%). Aortic plaques were found in 502 patients (27.4%). Among these, complex aortic plaques, which are significant sources of embolism, were found in 157 patients (8.5%). Changes in treatment strategies for secondary prevention based on the current guidelines would have been necessary in 63 patients (3.4 %) after TOE examination.

Conclusion Potential embolic sources from the heart and aorta can be detected by TOE examination in many patients with stroke with NSR and no cardiac disease, which enables a better determination of stroke mechanisms.

  • Embolism
  • infarction
  • transoesophageal echocardiography
  • cerebrovascular disease

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Footnotes

  • Funding This work was supported by a grant of the Korea Healthcare technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (A060171, A085136).

  • Competing interests None.

  • Ethics approval This study was approved by the Institutional Review Board of Severance Hospital, Yonsei University Health System.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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