Echocardiography In Stroke Research Articles

Comparing the diagnostic value of Echocardiography In Stroke (CEIS) \u2013 results of a prospective observatory cohort study

BackgroundEchocardiography is one of the main diagnostic tools for the diagnostic workup of stroke and is already well integrated into the clinical workup. However, the value of transthoracic vs. transesophageal echocardiography (TTE/TEE) in stroke patients is still a matter of debate. Aim of this study was to characterize relevant findings of TTE and TEE in the management of stroke patients and to correlate them with subsequent clinical decisions and therapies.MethodsWe evaluated n = 107 patients admitted with an ischemic stroke or transient ischemic attack to our stroke unit of our university medical center. They underwent TTE and TEE examination by different blinded investigators.ResultsMajor cardiac risk factors were found in 8 of 98 (8.2%) patients and minor cardiac risk factors for stroke were found in 108 cases. We found a change in therapeutic regime after TTE or TEE in 22 (22.5%) cases, in 5 (5%) cases TEE leads to the change of therapeutic regime, in 4 (4%) TTE and in 13 cases (13.3%) TTE and TEE lead to the same change in therapeutic regime. The major therapy change was the indication to close a patent foramen ovale (PFO) in 9 (9.2%) patients with TTE and in 10 (10.2%) patients with TEE (p = 1.000).ConclusionMajor finding with clinical impact on therapy change is the detection of PFO. But for the detection of PFO, TTE is non inferior to TEE, implicating that TTE serves as a good screening tool for detection of PFO, especially in young age patients.Trial registrationThe trial was registered and approved prior to inclusion by our local ethics committee (1/3/17).

Brief history of patent foramen ovale and stroke.

Lechat is usually credited with first calling attention to patent foramen ovale (PFO) and stroke in 1988.1 Previous studies of the role of echocardiography in stroke rarely, if ever, mentioned PFO and focused on now-almost-forgotten disorders, such as mitral valve prolapse.2 Interest in PFO has emerged for 3 main reasons: (1) renewed interest in cryptogenic stroke especially in younger patients; (2) technical advances, including bubble contrast transthoracic echocardiography, transesophageal echocardiography, and saline contrast transcranial doppler; and (3) perhaps most importantly, the emergence of endovascular device closure as a treatment option. Cryptogenic stroke is highly prevalent in stroke populations under the age of 55 years. Many of these patients have circumstantial evidence for embolism on MR, such as cortical infarct location or multiple silent infarcts in different vascular territories. Large PFO with a substantial shunt and atrial septal aneurysm has been identified in many (although not all) studies as anatomic comorbidities associated with stroke. However, as with PFO detection, new technology, including implantable cardiac monitors and MR plaque morphological analysis, has identified occult atrial fibrillation and acute rupture of benign atherosclerotic plaques as underdiagnosed causes of crytpogenic stroke.3 This suggests that in many patients with cryptogenic stroke, a PFO may be coincidental. The explosion of device technology has played a central role in the PFO renaissance. Reimbursement policies and an inherent bias in young patients with stroke to close the hole bolstered by numerous observational case series provided a strong incentive for endovascular device closure.4 With this background, 3 randomized clinical trials of the management of patients with cryptogenic stroke and PFO have recently been completed. Given the lingering controversy, it is important to review why the Evaluation of the STARFlex Septal Closure System in Patients With a Stroke and/or Transient Ischemic Attack Due to Presumed Paradoxical …

Diagnostic yield of echocardiography in stroke: Should we improve patient selection?

IntroductionLast year the European Society of Echocardiography published recommendations for the use of echocardiography in identifying potential sources of embolism as a cause of ischaemic stroke in the absence of other cerebrovascular disease. Both transthoracic echocardiography (TTE) and transoesophageal echocardiography play a fundamental role in the assessment, diagnosis and management of the embolic source. Due, in part, to the increased longevity of the population and improved survival of cardiac patients, we are now seeing a gradual increase in the application of echocardiographic studies as a diagnostic test. This has led us to critically analyse their performance in the various pathologies. ObjectiveOur aim was to analyse the diagnostic yield of TTE in patients with cerebrovascular accident in a tertiary hospital. Materials and methodsFor this, we retrospectively analysed all echocardiographic studies during 2010 requested from the Neurology Department with a diagnosis of stroke. We have studied the diagnostic yield of the test and its contribution to the etiological diagnosis based on major and minor echocardiographic criteria as recommended by the European Society of Echocardiography. ResultsWe found major echocardiographic criteria in 6 patients (5%) with embolic stroke and in 2 (0.7%) non-embolic stroke, P=.005. In view of our results, the performance of TTE in patients with embolic stroke has a low diagnostic yield, which leads us to consider the systematic use of this technique.

Echocardiography in stroke and the prescription of new anticoagulation and cardiac medications: A pilot project

Previous research on echocardiography in patients with acute stroke has focused on identifying possible cardioembolic etiologies of the stroke, but physicians might also obtain echocardiography to guide the management of heart disease in stroke patients. The objectives of this study were to determine how frequently echocardiography is used in acute ischemic stroke patients, and to evaluate if receiving echocardiography is associated with new prescriptions for anticoagulant or cardiac medications. This secondary data analysis of a previous cohort study included medical records of acute ischemic stroke patients admitted to 1 of 10 acute-care hospitals in Connecticut from 1996 to 1998. A total of 58 of 119 (49%) acute ischemic stroke patients received echocardiography. Among these 58 patients, 43 (74%) received either a new prescription for anticoagulation or a new cardiac medication prescription (10 of 58 [17%] new anticoagulation only, 22 of 58 [38%] new cardiac medication only, and 11 of 58 [19%] both). New anticoagulant medications were prescribed more often in patients receiving echocardiography (21 of 58; 36%), than in patients not receiving echocardiography (10 of 61; 16%) (P = .014). In addition, new cardiac medications were prescribed more often in patients receiving echocardiography (34 of 58; 59%), than in patients not receiving echocardiography (24 of 61; 39%) (P = .035). Echocardiography is commonly obtained in patients with acute stroke, and its use is associated with both the prescription of new anticoagulation and new cardiac medications. Although previous research about the use of echocardiography in acute stroke has focused on its role in identifying stroke etiologies, future research should include an assessment of it use in treating concomitant heart disease.

Transesophageal echocardiography in stroke.

Fifteen to twenty percent of all ischemic strokes are of cardioembolic origin. Since the introduction of transesophageal echocardiography (TEE) in 1976, its clinical application in the diagnosis of cardioembolic stroke has expanded greatly. Comprehensive literature has accumulated showing TEE as an invaluable tool for the diagnosis of cardioembolic stroke because it allows superior visualization of established embolic stroke risk factors (apical thrombus, endocarditis) as well as the identification of newer factors (patent foramen ovale, aortic arch plaques, etc.). In this article, we summarize the present status of TEE in the diagnostic workup of stroke.

Echocardiography in stroke and transient ischaemic attack.

Echocardiography in stroke and transient ischaemic attack.

Stroke Patterns with Atrial Septal Aneurysm

We studied 12 patients (6 men and 6 women) with a mean age of 47 years with stroke (n = 11) or transient ischemic attack (n = 1) in relation with an atrial septal aneurysm. Ten patients showed also a patent foramen ovale. Infarcts involved the posterior cerebral artery (n = 3), superficial middle cerebral artery (n = 2), deep middle cerebral artery (n = 3), deep and superficial middle cerebral artery (n = 1), posterior inferior cerebellar artery (n = 1) and posterior inferior cerebellar and superficial middle cerebral artery (n = 1) territories. Embolism was likely in all patients, although coexisting small-artery disease could not be excluded in 2 patients. The exact mechanism remained unsettled, although paradoxical embolization of thrombi formed within the aneurysm through the interatrial wall should be considered. Our study emphasizes the importance of detecting potential cardiac sources of embolism by routine transthoracic and transesophageal echocardiography in stroke of unknown origin.

Detection of a left atrial myxoma by systematic transesophageal echocardiography in stroke

Detection of a left atrial myxoma by systematic transesophageal echocardiography in stroke