Comparing Multislice Electrocardiogram-gated Spiral Computerized Tomography and Transesophageal Echocardiography in Evaluating Aortic Atheroma in Patients with Acute Ischemic Stroke

Abstract

The aim of this study was to compare transesophageal echocardiography (TEE) and cardiac-gated computerized tomography (CGCT) in detecting aortic atherosclerosis (AA). There is evidence that AA can be a source of embolic material causing ischemic stroke. TEE is a well-established tool for detecting cardiac sources of emboli in patients with stroke, but it has distinct limitations in the detection of AA. This was a prospective study of patients admitted with the diagnosis of ischemic stroke between February and November of 2000. Among this cohort are patients who underwent both TEE and CGCT for the evaluation of stroke cause. The CGCT studies were retrieved and interpreted by a radiologist with special expertise in chest tomography, and TEE studies were read by an echocardiographer with special expertise in reading and performing TEE. The interpreters were unaware of the results obtained by the other. The AA was estimated by measuring atheroma thickness in millimeters. The relations between the two tests were analyzed graphically using Bland-Altman, and Pollock plots. Results from Pearson (r), Spearman (r(s)), and intraclass correlation tests were also estimated. The aortic atheroma thickness in millimeters was compared between CGCT and TEE in 32 patients, who underwent both studies. The intraclass correlation was 0.93, with high correlation (r = 082, r(s) = 0.83). CGCT detected smaller AA more often, and provided more information about the shape of atheromatous plaques. CGCT is similar to TEE in detecting AA. CGCT may detect smaller atheromas and be better in defining atheroma morphology.