TRANSESOPHAGEAL ECHOCARDIOGRAPHIC FINDINGS IN STROKE SUBTYPES

Background and Purpose Transesophageal echocardiography has a high yie ld for detecting potential cardiac sources of embolism in patients wit h clinical risk factors for cardioembolism or unexplained stroke. The yield in other stroke subtypes is unknown. Methods We classified 145 c onsecutively admitted patients into stroke subtypes based on clinical findings, brain imaging, and carotid ultrasound. Both transesophageal and transthoracic echocardiography were performed to detect left atria l thrombi, spontaneous echo contrast, atrial septal aneurysm, interatr ial shunts, ventricular thrombus or aneurysm, and myxomatous mitral va lve. Results Transesophageal echocardiography documented at least one of these findings in 46% of the patients compared with an 8% yield on the transthoracic study (P=.002). The yield of transesophageal echocar diography was substantial in all stroke subgroups. Patients with clini cal risk factors for cardiac embolism had the highest frequency of spo ntaneous echo contrast (P=.001). Atrial septal aneurysms were most fre quent in patients with lacunar syndromes (P=.012), and interatrial shu nts were common in all stroke subtypes. Conclusions Transesophageal ec hocardiographic findings vary considerably between stroke subgroups.