Abstract 18759: Benefit of TEE in Patients Over 50 with Unexplained Stroke and Normal TTE Study

Abstract

Objective: Aside from oral anticoagulation in patients with intracardiac thrombus, current guidelines and scientific evidence do not support specific therapeutic interventions for most other TEE findings. We sought to examine the effect of performing TEE on therapeutic management in patients over age 50 with unexplained stroke. Specific TEE findings sought to explain the cause of stroke generally include cardiac thrombi (particularly LA and LAA) or spontaneous contrast, inter atrial septal anomalies (particularly PFO), and atheromatous disease of the aorta. We hypothesized that there would be minimal incremental value in performing TEE added to a normal TTE study.

Methods: We retrospectively analyzed consecutive patients over 50 yrs who underwent TEE for unexplained stroke. Patients in sinus rhythm were included if TTE results were normal. Normal TTE was defined as normal LVEF, no intracardiac masses or shunts, absence of severe valvular heart disease.

Results: TEE images and clinical data of 263 patients were analyzed. Baseline characteristics included mean age of 66.7 yrs, (range 50-91 yrs), 42.5% were female. TEE findings demonstrated complex plaque of the ascending aorta or arch in 44/263 (16.7%). PFO was found in 18/263(%), 25/263(%) had atrial spetal aneurysm (ASA), and 11/263(%) had both ASA and PFO. Spontaneous contrast was seen in 13/263 (4.9%). 1 patient had LA thrombus. Overall 38% had a TEE finding which could explain the etiology of stroke but 1/263 (0.4%) had a finding which changed therapy based on current guidelines or substantial scientific evidence. 6 months follow up was available on 85 patients, and 13(15%) of these patients developed new PAF.

Conclusions: Our study demonstrates no incremental value of TEE to a normal TTE study in patients over 50 with unexplained stroke in sinus rhythm. As reported in prior studies, it is not uncommon for TEE to disclose findings such as aortic atheroma or interatrial septal anomalies, however these findings generally do not alter therapeutic management and therefore routine performance of TEE in these patients may not be justified. It needs to be determined whether subsequent PAF episodes were etiology or result of stroke.