Document Detail

Routine transesophageal echocardiography for the evaluation of cerebral emboli in elderly patients.
MedLine Citation:
PMID:  16194171     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Approximately 20% of cerebral infarctions are cardioembolic in nature. Transesophageal echocardiography (TEE) is widely regarded as the initial study of choice for evaluating cardiac source of embolism. Although the majority of cerebrovascular accidents occur in elderly patients, the value of TEE in this population is poorly defined. METHODS: We compared 491 patients older than 65 years with suspected embolic stroke or transient ischemic attack (TIA) who had undergone TEE evaluation between April 2000 and February 2004 to an age-, sex-, and time-matched control group that consisted of 252 patients. Studies were reviewed for abnormalities associated with thromboembolic disease. RESULTS: The overall incidence of stroke risk factors was significantly higher in the study than in the control group. However, the four patients with left atrial thrombi had a history of atrial fibrillation. Although ascending and aortic arch sessile atheromata were observed more frequently in the study than control group, there were no significant differences in the incidence of either complex or mobile aortic atheromata. The incidence of atrial septal aneurysm was higher in the stroke/TIA group, but not in association with patent foramen ovale. Finally, there were also no differences in the incidence of spontaneous echocontrast, and/or patent foramen ovale between study and control groups. CONCLUSIONS: We conclude: (1) There is a higher incidence of abnormalities implicated as sources of thromboembolic disease on TEE in elderly patients with cerebral infarctions, but (2) this incidence is driven by the presence of sessile aortic atheroma and atrial septal aneurysm. Until the benefits of specific therapies for these conditions are known, routine TEE in elderly patients with suspected embolic neurological events appears to be unwarranted.
Sergey Vitebskiy; Keith Fox; Brian D Hoit
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Echocardiography (Mount Kisco, N.Y.)     Volume:  22     ISSN:  0742-2822     ISO Abbreviation:  Echocardiography     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-09-30     Completed Date:  2006-01-12     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8511187     Medline TA:  Echocardiography     Country:  United States    
Other Details:
Languages:  eng     Pagination:  770-4     Citation Subset:  IM    
University Hospitals of Cleveland and Case Western Reserve University, Cleveland, OH 44106-5038, USA.
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MeSH Terms
Aged, 80 and over
Aorta, Thoracic / ultrasonography
Aortic Diseases / ultrasonography
Atherosclerosis / ultrasonography
Atrial Fibrillation / complications
Case-Control Studies
Echocardiography, Transesophageal*
Heart Aneurysm / ultrasonography
Heart Atria / ultrasonography
Heart Diseases / ultrasonography*
Heart Septal Defects, Atrial / ultrasonography
Heart Septum / ultrasonography
Intracranial Embolism / ultrasonography*
Ischemic Attack, Transient / ultrasonography
Retrospective Studies
Risk Factors
Stroke / ultrasonography
Thrombosis / ultrasonography*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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