Key result
Widespread TEE screening fails to increase diagnostic yield for cardiogenic embolism in TIA and stroke.
Why the study?
The proportion of cardiogenic embolism among TIA and ischemic stroke patients and the diagnostic yield of widespread transesophageal echocardiography screening were uncertain.
Does widespread screening with transesophageal echocardiography increase the diagnosis of cardiogenic embolism in patients with TIA or ischemic stroke?
Observational
Yes
Does widespread screening with transesophageal echocardiography increase the diagnosis of cardiogenic embolism in patients with TIA or ischemic stroke?
Widespread screening with transesophageal echocardiography does not significantly increase the diagnostic yield for cardiogenic embolism in stroke patients compared to conventional clinical and echocardiographic evaluation.
May not justify routine TEE screening in TIA or stroke; leaves open targeted use in select patients.
About 17% of all transient ischemic attacks (TIA) and ischemic strokes were due to cardiogenic embolism in three prospective stroke registries (Berlin, Giessen, Klosterneuburg). Most of these patients can be identified by history, clinical examination, conventional ECG, and appropriate use of echocardiography. Widespread screening of stroke patients with transesophageal echocardiography, as intented in the protocol of two registries, did not appreciably increase the portion of patients with the final diagnosis of cardiogenic embolism, although, in many cases, minor-risk embolic sources can be identified. Prognosis for death or early recurrence after cardiogenic brain embolism was not worse than assumed previously.
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Hornig et al. (1994) conducted an observational in Transient ischemic attacks (TIA) and ischemic strokes. Transesophageal echocardiography screening vs. Conventional diagnostic methods (history, clinical examination, ECG, conventional echocardiography) was evaluated on Proportion of TIA and ischemic strokes due to cardiogenic embolism. Cardiogenic embolism accounted for about 17% of TIAs and ischemic strokes, and widespread screening with transesophageal echocardiography did not appreciably increase this diagnostic yield.
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