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Transesophageal echocardiography and carotid ultrasound in patients with cerebral ischemia: prevalence of findings and recurrent stroke risk.

Abstract：

OBJECTIVES:This study was conducted to determine the yield of transesophageal echocardiographic findings in a consecutive series of patients with stroke and transient ischemic attack, with and without carotid stenosis, and to estimate the recurrent stroke risk associated with specific echocardiographic findings. BACKGROUND:Transesophageal echocardiography has a high yield for identification of potential sources of cardiac embolism in patients with cerebral ischemia; however, the clinical significance of the most commonly detected abnormalities is uncertain. METHODS:We evaluated 145 consecutively admitted patients with stroke or transient ischemic attack with both transesophageal echocardiography and carotid ultrasound. Patients were followed up prospectively for a mean duration of 18 months to document the rate of recurrent cerebral ischemia. RESULTS:Transesophageal echocardiography detected at least one potential cardiac source of embolism in 45% of the patients. Atrial septal aneurysm and interatrial shunt were detected more frequently in patients who did not have a significant carotid stenosis that could account for their ischemic event. During follow-up, a higher rate of recurrent stroke or transient ischemic attack occurred in patients with positive transesophageal echocardiographic findings, particularly atrial septal aneurysm, interatrial shunt and left atrial thrombus. CONCLUSIONS:These data support recent studies that suggest that atrial septal aneurysm and interatrial shunts may be a significant source of cardioembolic stroke. Further studies are needed to clarify the optimal management of patients with these abnormalities.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Comess KA,DeRook FA,Beach KW,Lytle NJ,Golby AJ,Albers GW

doi

10.1016/0735-1097(94)90662-9

subject

Has Abstract

pub_date

1994-06-01 00:00:00

pages

1598-603

issue

7

eissn

0735-1097

issn

1558-3597

pii

0735-1097(94)90662-9

journal_volume

23

pub_type

杂志文章

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