A H Katsanos1,2, S Giannopoulos1, A Frogoudaki3, A-R Vrettou3, I Ikonomidis3, I Paraskevaidis3, C Zompola2, K Vadikolias4, E Boviatsis5, J Parissis3, K Voumvourakis2, A P Kyritsis1, G Tsivgoulis2,4,6. 1. Department of Neurology, School of Medicine, University of Ioannina, Ioannina, Greece. 2. Second Department of Neurology, 'Attikon University Hospital', School of Medicine, University of Athens, Athens, Greece. 3. Second Department of Cardiology, 'Attikon University Hospital', School of Medicine, University of Athens, Athens, Greece. 4. Department of Neurology, Democritus University of Thrace, Alexandroupolis, Greece. 5. Second Department of Neurosurgery, 'Attikon University Hospital', School of Medicine, University of Athens, Athens, Greece. 6. International Clinical Research Center, Department of Neurology, St Anne's University Hospital, Brno, Czech Republic.
Abstract
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 PFOs 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.
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 PFOs 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.
Authors: Aristeidis H Katsanos; Rohini Bhole; Alexandra Frogoudaki; Sotirios Giannopoulos; Nitin Goyal; Agathi-Rosa Vrettou; Ignatios Ikonomidis; Ioannis Paraskevaidis; Konstantinos Pappas; John Parissis; Athanassios P Kyritsis; Anne W Alexandrov; Nikos Triantafyllou; Marc D Malkoff; Konstantinos Voumvourakis; Andrei V Alexandrov; Georgios Tsivgoulis Journal: Neurology Date: 2016-08-03 Impact factor: 9.910
Authors: Marlena Schnieder; Mohammed Chebbok; Jan Liman; Marco Robin Schroeter; Michael Didié; Frieder Wolf; Mostafa Badr; Ibrahim Allam; Mathias Bähr; Gerd Hasenfuß Journal: BMC Neurol Date: 2021-03-17 Impact factor: 2.474
Authors: Renate B Schnabel; Stephan Camen; Fabian Knebel; Andreas Hagendorff; Udo Bavendiek; Michael Böhm; Wolfram Doehner; Matthias Endres; Klaus Gröschel; Andreas Goette; Hagen B Huttner; Christoph Jensen; Paulus Kirchhof; Grigorios Korosoglou; Ulrich Laufs; Jan Liman; Caroline Morbach; Darius Günther Nabavi; Tobias Neumann-Haefelin; Waltraud Pfeilschifter; Sven Poli; Timolaos Rizos; Andreas Rolf; Joachim Röther; Wolf Rüdiger Schäbitz; Thorsten Steiner; Götz Thomalla; Rolf Wachter; Karl Georg Haeusler Journal: Clin Res Cardiol Date: 2021-06-18 Impact factor: 5.460