Utility Of Transesophageal Echocardiogram In Acute Ischemic Stroke For Cardioembolic Sources Diagnosis: A Retrospective Cohort Study In A Third Level Hospital In Buenos Aires, Argentina.
Alejandra Heriz1, Rocio Marquez1, Jeremias Ayerbe1, Juan Pablo Rodriguez1, Rodrigo Sanjinez1, Facundo Escandon1, Otto Vega1, Guido Stupenengo1, Natalia Balian1, Marcelo Rugiero Rodriguez1
1Hospital Italiano de Buenos Aires
Objective:
To describe and analyze the proportion, characteristics, and predictors for changes in therapeutic management in adults with acute ischemic stroke (AIS) who underwent a transesophageal echocardiogram (TEE).
Background:
Cerebrovascular disease is a major cause of acquired disability and up to 30% of strokes have a cardioembolic source. Echocardiography plays an important role in its early identification and is a routine study during stroke workup. However, it is still unclear which patients might benefit from TEE.
Design/Methods:
A retrospective cohort study was conducted between October 1st, 2015, and September 30th, 2022, which included adults with AIS who underwent TEE. Patients with small vessel occlusion or large artery atherosclerotic stroke were excluded.
A change in therapeutic management was defined as the indication of anticoagulation or antibiotics, or when cardiac surgery was performed related to TEE findings.
Major and minor cardioembolic sources were defined according to the ACE guidelines classification.
Results:
624 observations were included. The median age was 76 years (IQR 17) and 45.3% were male. A major cardioembolic source was found in 6.7 % of the patients, and a minor source in 29,6%. Changes in therapeutic management occurred in 103 patients (16%). In multivariable logistic regression, age and history of myocardial infarction were independently associated with changes in therapeutic management, OR 0.98 (CI95%, 0.97-0.99, p=0.03) and OR 2.33 (CI95%, 1.03-5.01, p=0.03) respectively. No association with this outcome was found in bivariate analysis.
In the group of patients with changes in therapeutic management, 70.9% had only minor cardioembolic sources, 24.3% only major sources, and 16.5% had both.
Conclusions:
16% of TEE findings were associated with changes in therapeutic management and minor cardioembolic sources were the main cause. Also, age and history of myocardial infarction were independently associated with changes in therapeutic management.