Background: Transesophageal echocardiography (TEE) is the gold standard for detecting potential cardiac sources of embolism (PCSE). However, the role of TEE in ischaemic stroke patients with normal sinus rhythm (NSR) and no cardiac disease remains uncertain.
Methods: We retrospectively analysed 1833 consecutive ischaemic stroke patients with NSR and no history of cardiac disease who were examined by TEE. We 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 (TOAST) classification. We also determined how the proportions of stroke subtypes and treatment strategies based on current guidelines have been changed after TEE.
Results: PCSE and/or aortic plaques were detected in 753 (41.1%) of 1833 patients. After TEE, 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 of treatment strategies for secondary prevention based on the current guidelines would have been necessary in 63 patients (3.4 %) after TEE examination.
Conclusion: Potential embolic sources from the heart and aorta can be detected by TEE examination in many stroke patients with NSR and no cardiac disease, which enables a better determination of stroke mechanisms.