4 . 2023

Transoesophageal echocardiography in patients with ischemic stroke

Abstract

Background. Diagnosis of sources of cardiocerebral embolisms in patients with ischemic stroke.

The aim of the study was to assess the diagnostic significance of transoesophageal echocardiography for verifying possible sources of cardiocerebral embolisms, clarifying the pathogenetic subtype of ischemic stroke up to a year ago in patients of a neurological hospital.

Material and methods. The retrospective study included 172 patients [122 men (70.9%), 50 women (29.1%); average age – 54±12 years] with data requiring clarification based on the results of transthoracic echocardiography (TTE), with cryptogenic pathogenetic variant of ischemic stroke, stroke in the young adults.

Results. Prognostically important findings were identified by TEE in 29.6% of patients (51): patent foramen ovale with left-to-right shunt – in 24 (13.9%) patients, left atrial myxoma – in 2 (1.2%), Lambl’s excrescences on the aortic valve cusps – in 1 (0.6%), vegetations on the aortic valve cusps – in 1 (0.6%), vegetations on a mechanical mitral valve prosthesis – in 1 (0.6%) , periprosthetic fistula of the mitral valve prosthesis – in 1 (0.6%), membrane in the outflow tract of the left ventricle – in 1 (0.6%), lipomatosis of the coumarin ridge and interatrial septum – in 1 (0.6%), in 11 (6.4%) patients the effect of spontaneous echo contrast was detected, of which 4 (2.3%) – only in the left atrial appendage, 7 (4.1%) – both in the appendage and in the cavity the leftmost atrium.

Patients with the presence of intracardiac thrombi and/or echocontrast were older compared to patients without them (63±11 vs 53±11 years; p=0.003), and they were more likely to have atrial fibrillation (56.3 vs 4.8%, p<0.0005), the left atrial enlargement index was higher, ml/m² of body surface (median 46 [35; 60] vs 26 [23; 34], p<0.0005), the blood flow velocity in the left atrial appendage was reduced, cm/s (median 25 [22; 50] ] versus 65 [55; 80], p<0.0005), more often there were areas of impaired local contractility of the LV (37.5 vs 6.5%, p<0.0005), the left ventricular ejection fraction was lower, % (median 58 [47; 62] vs 65 [62; 67], p=0.008). All assessed parameters did not differ in patients with and without a patent foramen ovale. Atherosclerosis of the descending aorta was detected in 92 people (53.4%). Patients with aortic atherosclerosis were older (59±10 years vs 48±11 years; p<0.0005), and they were more likely to have arterial hypertension (98.9% vs 87.3%, p=0.003). The thickness of atherosclerotic plaques, mm, was significantly greater in the presence of hyperechoic inclusions (median 2.7 [2.2; 3.5] vs 1.8 [1.6; 2.0], p=0.045) and crater (median 5.0 [4.6; 15.8] vs 2.2 [1.8; 2.8]; p<0.0005). In persons with aortoatheromas, adjusted for age, atherosclerosis of the brachiocephalic vessels was more pronounced (for the right subclavian artery 51.5 vs 16.9%; p=0.001; left common carotid artery 52.1 vs 25.4%, p=0.016; right internal carotid artery 47.9 vs 24.1%; p=0.032).

Conclusion. Based on the results of TEE, compared with TTE, it was possible to identify potentially embologenic intracardiac formations. The data obtained helped to establish the pathogenetic variant of ischemic stroke and individualize secondary prevention.

Keywords:transoesophageal echocardiography; ischemic stroke; transthoracic echocardiography; aortic atherosclerosis; patent foramen ovale

Funding. The study was carried out within the framework of State Assignment No. 388-00083-22-00 of 30.12.2021, registration number NIR 122022100113-7 of February 21, 2022.

Conflict of interest. The authors declare no conflict of interest.

For citation: Medvedeva N.M., Sedov V.P., Berdalin A.B., Lelyuk V.G. Transoesophageal echocardiography in patients with ischemic stroke. Clinical and Experimental Surgery. Petrovsky Journal. 2023; 11 (4): 106–15. DOI: https://doi.org/10.33029/2308-1198-2023-11-4-106-115 (in Russian)

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