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The diagnostic yield of transesophageal echocardiography in patients with cryptogenic cerebral ischaemia: a meta‐analysis
Author(s) -
Katsanos A. H.,
Giannopoulos S.,
Frogoudaki A.,
Vrettou A.R.,
Ikonomidis I.,
Paraskevaidis I.,
Zompola C.,
Vadikolias K.,
Boviatsis E.,
Parissis J.,
Voumvourakis K.,
Kyritsis A. P.,
Tsivgoulis G.
Publication year - 2016
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.12897
Subject(s) - medicine , patent foramen ovale , cardiology , intracardiac injection , confidence interval , stroke (engine) , aortic arch , meta analysis , thrombus , atheroma , ascending aorta , transesophageal echocardiogram , radiology , aorta , migraine , mechanical engineering , engineering
Background and purpose The diagnostic utility of transesophageal echocardiography ( TEE ) in patients with cryptogenic ischaemic stroke ( IS ) or transient ischaemic attack ( TIA ) remains controversial. Methods A systematic review and meta‐analysis was performed according to PRISMA guidelines to estimate the pooled prevalence of potential cardioembolic causes detected by TEE in prospective observational studies of cryptogenic IS / TIA . Cardiac conditions causally associated with cerebral ischaemia were considered to be intramural thrombi and intracardiac tumors according to ASCO phenotyping of IS . Results Thirty‐five eligible studies, comprising 5772 patients (mean age 53.6 years, 56.9% men) were identified. The most common TEE finding was ascending aorta and/or aortic arch atheroma [51.2% (27.4%–74.5%)], followed by patent foramen ovale ( PFO ) [43.2% (36.3%–50.4%)]. Complex aortic plaques and large PFO s were reported in 14% (10.2%–18.9%) and 19.5% (16.6%–22.8%) of TEE evaluations. The prevalence of atrial septal aneurysm was 12.3% (7.9%–18.7%) and was significantly higher in conjunction with PFO presence (risk ratio 2.04, 95% confidence interval 1.63–2.54, P < 0.001). The prevalence of left atrial thrombus [3.0% (1.1%–8.3%)] and spontaneous echo contrast [3.8% (2.3%–6.2%)] was low. The prevalence of intracardiac tumors was extremely uncommon [0.2% (0%–0.7%)]. Significant heterogeneity was identified ( I 2 > 60%) in the majority of analyses. Heterogeneity was not affected by cryptogenic stroke definition ( TOAST versus alternative criteria). After dichotomizing available studies using a cut‐off of 50 years, PFO was significantly ( P = 0.001) more prevalent in younger than in older patients. Conclusion Routine TEE in patients with cryptogenic IS / TIA commonly identifies abnormal findings. However, the prevalence of cardiac conditions considered to be causally associated with cerebral ischaemia (intracardiac thrombi and tumors) is low.