The transesophageal echocardiogram in the evaluation of cerebrovascular diseases.

Abstract

We evaluated the diagnostic sensitivity and clinical value of transesophageal echocardiogram in 72 patients with a potential cardiogenic embolic stroke or transient ischemic attacks at the Neurological Department/Cerebrovascular disorders out-patient clinic of Santa Maria Hospital between February 1991 - February 1993. The transesophageal echocardiogram was performed in UTIC-Arsénio Cordeiro after current diagnostic evaluation. Eighteen patients had previous cardiac disease and in 58 the transthoracic echocardiogram was normal. Transesophageal echocardiography detected the presence of cardiac abnormalities in 49 patients (68%) and a potential cardiac embolic source in 38 (53%). Twenty-eight patients were started on anticoagulants. The most frequent cardiogenic embolic sources were: patent foramen ovale, atrial septal aneurysm and a left auricular/auricular appendicular dilatation. Twelve of these patients, who had a non cardiac cause for their stroke, were considered as a control group. The remaining cases (n = 60) had significantly more (+32%; 95% CI = 2-62) cardiac abnormalities than this control group. We performed a separate analysis of 3 subgroups of patients: 1--without and 2--with cardiac disease; 3--age < or = 45 years. No significant differences were found between group 1 and 2. Among the subjects aged < or = 45 years, undiagnosed cardiopathy was less frequent (-21%; 95% CI = 1-43). These results confirm the diagnostic sensitivity and the clinical value of transesophageal echocardiogram in detecting potential embolic sources in patients with stroke/transient ischemic attacks irrespective of age or previous cardiac disease.