1. Treatment-Relevant Findings in Transesophageal Echocardiography After Stroke: A Prospective Multicenter Cohort Study
- Author
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Renate B. Schnabel, Märit Jensen, Julian Schröder, Stephan Camen, Mira Upneja, Götz Thomalla, Henning Clausen, Ewgenia Barow, Max Nedelmann, Christian Gerloff, Frank Andres, Elke Leinisch, Stefan Blankenberg, Bastian Cheng, Christoph Sinning, Andreas Steinbrecher, Stefan Boskamp, Birgit Ostermeier, Claudia Tiburtius, Michael Rosenkranz, and Sandra Kissling
- Subjects
Male ,medicine.medical_specialty ,Heart Diseases ,Cardiac Ultrasound ,Cohort Studies ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Stroke ,Acute ischemic stroke ,Aged ,Advanced and Specialized Nursing ,Foramen ovale patent ,business.industry ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Treatment Outcome ,Echocardiography ,Ischemic stroke ,Cardiology ,Female ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,human activities ,Echocardiography, Transesophageal ,Cohort study - Abstract
Background and Purpose: Cardiac ultrasound to identify sources of cardioembolism is part of the diagnostic workup of acute ischemic stroke. Recommendations on whether transesophageal echocardiography (TEE) should be performed in addition to transthoracic echocardiography (TTE) are controversial. We aimed to determine the incremental diagnostic yield of TEE in addition to TTE in patients with acute ischemic stroke with undetermined cause. Methods: In a prospective, observational, pragmatic multicenter cohort study, patients with acute ischemic stroke or transient ischemic attack with undetermined cause before cardiac ultrasound were studied by TTE and TEE. The primary outcome was the rate of treatment-relevant findings in TTE and TEE as defined by a panel of experts based on current evidence. Further outcomes included the rate of changes in the assessment of stroke cause after TEE. Results: Between July 1, 2017, and June 30, 2019, we enrolled 494 patients, of whom 492 (99.6%) received TTE and 454 (91.9%) received TEE. Mean age was 64.7 years, and 204 (41.3%) were women. TEE showed a higher rate of treatment-relevant findings than TTE (86 [18.9%] versus 64 [14.1%], P P Conclusions: In patients with undetermined cause of stroke, TEE yielded a higher number of treatment-relevant findings than TTE. TEE appears especially useful in younger patients with stroke, with treatment-relevant findings in one out of seven patients ≤60 years. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03411642.
- Published
- 2022
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