Background and Purpose:Cardiac ultrasound to identify sources of cardioembolism is part of the diagnostic workup of acute ischemic stroke. Recommendations on whether transesophageal echocardiography (TEE) should be performed in addition to transthoracic echocardiography (TTE) are controversial. We aimed to determine the incremental diagnostic yield of TEE in addition to TTE in patients with acute ischemic stroke with undetermined cause.Methods:In a prospective, observational, pragmatic multicenter cohort study, patients with acute ischemic stroke or transient ischemic attack with undetermined cause before cardiac ultrasound were studied by TTE and TEE. The primary outcome was the rate of treatment-relevant findings in TTE and TEE as defined by a panel of experts based on current evidence. Further outcomes included the rate of changes in the assessment of stroke cause after TEE.Results:Between July 1, 2017, and June 30, 2019, we enrolled 494 patients, of whom 492 (99.6%) received TTE and 454 (91.9%) received TEE. Mean age was 64.7 years, and 204 (41.3%) were women. TEE showed a higher rate of treatment-relevant findings than TTE (86 [18.9%] versus 64 [14.1%], P<0.001). TEE in addition to TTE resulted in 29 (6.4%) additional patients with treatment-relevant findings. Among 191 patients ≤60 years additional treatment-relevant findings by TEE were observed in 27 (14.1%) patients. Classification of stroke cause changed after TEE in 52 of 453 patients (11.5%), resulting in a significant difference in the distribution of stroke cause before and after TEE (P<0.001).Conclusions:In patients with undetermined cause of stroke, TEE yielded a higher number of treatment-relevant findings than TTE. TEE appears especially useful in younger patients with stroke, with treatment-relevant findings in one out of seven patients ≤60 years.REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT03411642.

中文翻译：

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中风后经食道超声心动图的治疗相关发现：一项前瞻性多中心队列研究

背景和目的：心脏超声识别心源性栓塞的来源是急性缺血性卒中诊断检查的一部分。除经胸超声心动图 (TTE) 外，是否应进行经食道超声心动图 (TEE) 的建议存在争议。我们的目的是确定在不明原因急性缺血性卒中患者中除 TTE 外，TEE 的增量诊断率。方法：在一项前瞻性、观察性、务实的多中心队列研究中，急性缺血性卒中或原因不明的短暂性脑缺血发作患者TTE和TEE对心脏超声进行了研究。主要结果是专家小组根据当前证据定义的 TTE 和 TEE 中与治疗相关的发现率。进一步的结果包括 TEE 后卒中原因评估的变化率。 结果：在 2017 年 7 月 1 日至 2019 年 6 月 30 日期间，我们招募了 494 名患者，其中 492 名（99.6%）接受了 TTE，454 名（91.9%）收到 TEE。平均年龄为 64.7 岁，其中 204 人（41.3%）为女性。TEE 显示出比 TTE 更高的治疗相关发现率（86 [18.9%] 对 64 [14.1%]，P <0.001)。除了 TTE 之外，TEE 还导致 29 名 (6.4%) 患者出现了与治疗相关的发现。在 191 名≤60 岁的患者中，27 名 (14.1%) 患者通过 TEE 观察到了额外的治疗相关发现。453 例患者中，52 例（11.5%）在 TEE 后发生卒中原因分类发生变化，导致 TEE 前后卒中原因分布存在显着差异（P <0.001）。结论：在卒中原因不明的患者中，TEE 产生与 TTE 相比，治疗相关发现的数量更多。TEE 似乎对年轻的卒中患者特别有用，在 7 名≤60 岁的患者中有治疗相关发现。注册：URL：https://www.clinicaltrials.gov；唯一标识符：NCT03411642。