Ischemic stroke echocardiography

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S [2]

Overview

Echocardiography may be performed to determine the underlying etiology such as arrhythmias and the resultant clots in the heart that may spread to the brain vessels through the bloodstream.^[1]^[2]

Echocardiography

Echocardiography may help assess the structural cause and source of emboli in ischemic stroke.^[1]^[2]
It may also help assess risk factors for recurrent stroke such as atrial fibrillation, valvular heart disease and atherosclerosis.^[1]^[2]^[3]
Transesophageal echocardiography allows detection of high-risk PFO features, including large right-to-left shunt, atrial septal aneurysm, long PFO tunnel, and the presence of a Eustachian valve.^[4]

2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association[5]

2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association^[5]

Recommendations for Diagnostic Evaluation Referenced studies that support recommendations are summarized in online Data Supplements 1 and 2

Class IIa
6. In patients with cryptogenic stroke, echocardiography with or without contrast is reason-able to evaluate for possible cardiac sources of or transcardiac pathways for cerebral embolism.(Level of Evidence: B-R)

Class IIb
13. In patients with ESUS, transesophageal echocardiography (TEE), cardiac CT, or cardiac MRI might be reasonable to identify possible cardioaortic sources of or transcardiac pathways for cerebral embolism.(Level of Evidence: C-LD) 14. In patients with ischemic stroke or TIA in whom patent foramen ovale (PFO) closure would be contemplated, TCD (transcranial Doppler) with embolus detection might be reasonable to screen for right-to-left shunt.(Level of Evidence: C-LD)

For AHA/ASA guidelines for cardiac monitoring in patients with ischemic stroke, please click here

References

↑ ^1.0 ^1.1 ^1.2 de Abreu TT, Mateus S, Carreteiro C, Correia J (2008). “Therapeutic implications of transesophageal echocardiography after transthoracic echocardiography on acute stroke patients”. Vasc Health Risk Manag. 4 (1): 167–72. PMC 2464746. PMID 18629351.
↑ ^2.0 ^2.1 ^2.2 Ustrell X, Pellisé A (2010). “Cardiac workup of ischemic stroke”. Curr Cardiol Rev. 6 (3): 175–83. doi:10.2174/157340310791658721. PMC 2994109. PMID 21804776.
↑ Kolo PM, Sanya EO, Omotosho AB, Chijoke A, Dada SA (2010). “The role of echocardiography in the management of stroke”. West Afr J Med. 29 (4): 239–43. PMID 20931511.
↑ Mojadidi MK, Bogush N, Caceres JD, Msaouel P, Tobis JM. Diagnostic accuracy of transesophageal echocardiogram for the detection of patent foramen ovale: a meta-analysis. Echocardiography. 2014 Jul;31(6):752-8. doi: 10.1111/echo.12462. Epub 2013 Dec 23. PMID: 24372693.
↑ Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D; et al. (2021). “2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association”. Stroke. 52 (7): e364–e467. doi:10.1161/STR.0000000000000375. PMID 34024117 Check |pmid= value (help).

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[pmid18629351-1] 1.0 ^1.1 ^1.2 de Abreu TT, Mateus S, Carreteiro C, Correia J (2008). “Therapeutic implications of transesophageal echocardiography after transthoracic echocardiography on acute stroke patients”. Vasc Health Risk Manag. 4 (1): 167–72. PMC 2464746. PMID 18629351.

[pmid21804776-2] 2.0 ^2.1 ^2.2 Ustrell X, Pellisé A (2010). “Cardiac workup of ischemic stroke”. Curr Cardiol Rev. 6 (3): 175–83. doi:10.2174/157340310791658721. PMC 2994109. PMID 21804776.

[pmid20931511-3] Kolo PM, Sanya EO, Omotosho AB, Chijoke A, Dada SA (2010). “The role of echocardiography in the management of stroke”. West Afr J Med. 29 (4): 239–43. PMID 20931511.

[4] Mojadidi MK, Bogush N, Caceres JD, Msaouel P, Tobis JM. Diagnostic accuracy of transesophageal echocardiogram for the detection of patent foramen ovale: a meta-analysis. Echocardiography. 2014 Jul;31(6):752-8. doi: 10.1111/echo.12462. Epub 2013 Dec 23. PMID: 24372693.

[pmid34024117-5] Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D; et al. (2021). “2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association”. Stroke. 52 (7): e364–e467. doi:10.1161/STR.0000000000000375. PMID 34024117 Check |pmid= value (help).

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