Transesophageal Echocardiographic Detection of Cardiac Sources of Embolism in Elderly Patients with Ischemic Stroke

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Objective The aim of this study was to clarify the role of transesophageal echocardiography in detecting cardiac sources of embolism in elderly stroke patients. Methods We performed transesophageal echocardiography in 77 patients≥70 years old (mean 76.9) with ischemic stroke and investigated embolic sources. Thirty-seven patients were in sinus rhythm (SR) and 40 in atrial fibrillation (Af). Results Left atrial spontaneous echo contrast was detected in 73% of Af and in 14% of SR (p<0.01). Left atrial thrombus was present in 10% of Af and none of SR (p<0.05). Patent foramen ovale, atrial septa) aneurysm, and aortic atherosclerotic plaque≥4.0 mm in thickness in the proximal aortic arch were more commonly found in patients with SR. Conclusions In elderly ischemic stroke patients, 1) Left atrial spontaneous echo contrast and thrombus are more commonly detected in patients with Af, reflecting left atrial enlargement and blood stasis, and 2) atrial septal aneurysm, patent foramen ovale and aortic atherosclerotic plaque≥4.0 mm in thickness in the proximal aortic arch are important findings in patients with SR.
(Internal Medicine 38: 766-772, 1999)