2023 American Academy of Neurology Abstract Website

Objective:

To establish the proportion of cardioembolic sources on TEE vs TTE in patients with acute ischemic stroke (AIS) work-up.

Background:

Up to 30% of AIS are cardioembolic. Therefore, a correct assessment relies on early identification of the embolic source. For this reason, echocardiography is fundamental for proper diagnosis and treatment. However, it is still unclear which patients might benefit more from TEE rather than TTE.

Design/Methods:

A retrospective cohort study was conducted between October 1st, 2015, and September 30th, 2022, which included adults with AIS who underwent both TEE and TTE. Patients with small vessel occlusion or large artery atherosclerotic stroke were excluded. Major and minor cardioembolic sources were defined according to the ACE guidelines classification. Demographical, clinical and paraclinical data were collected from electronic records.

Results:

A total of 170 patients were included. Median age was 74 (IQR 19.8) and 44.1% were male. A cardioembolic source was found in 10.6% (18/170) of TTE and 37.6% (64/170) of TEE, having a statistically significant difference (χ2=27.7, p<0.01). This difference was still significant when stratified in both major and minor sources (p<0,01). 94.4% (17/18) of those found on TTE were also visible on TEE and only one wasn’t (left ventricle akinetic segment).

On TEE, main major sources were akinetic left ventricular segment (10.9%) and intracardiac vegetation (7.8%), while most frequent minor sources were patent foramen ovale (PFO) (43.8%), atrial septal aneurysm (25%) and spontaneous atrial echo contrast (15.6%). On TTE main major findings were akinetic left ventricular segment (33.3%) and intracardiac vegetation (16.7%), while most frequent minor finding was atrial septal aneurysm (33.3%).

Conclusions:

The proportion of minor, major and total cardioembolic sources findings on TEE were statistically higher compared to TTE.