Abstract Details

Title Transesophageal Echocardiography Changes Clinical Management in a Select Group of Acute Ischemic Stroke Patients

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P07 - (-)

Poster/Presentation
Number 239

Objective

Background BACKGROUND: There is no consensus on which patients should receive transesophageal echocardiography (TEE) in the diagnostic evaluation for stroke.

Design/Methods DESIGN/METHODS: From our prospectively collected stroke registry, we identified patients with ischemic stroke who received both TTE and TEE. A retrospective chart review was performed to collect clinical, radiographic, and echocardiographic features. Primary outcome measure was how often findings on TEE and TTE were different. This group was called 'TEE beneficial' since TEE provided new information. Secondary outcome measure was whether these differences led to a change in management or stroke etiology. Using logistic regression we identified clinical and radiographic findings that were predictive of having a 'beneficial' TEE.

Results RESULTS: A total of 252 patients had both TTE and TEE (52% male). Mean age was 57 ±14. TEE results were discordant with TTE in 116 (46%) patients (TEE beneficial). There were two discordant groups identified:false negative TTE (TTE normal, TEE abnormal) findings and false positive TTE (TTE abnormal, TEE normal) findings were demonstrated. When the TTE was falsely negative, the most common TEE findings were complex aortic disease, patent foramen ovale (PFO), and left atrial dilatation (LAD). When the TTE was falsely positive, the most common TTE findings were LAD, PFO, and regional wall motion abnormality. TEE changed clinical management or stroke etiology in 38 (15%) patients. Patients?62 years old (OR 1.79, 95% CI, 1.04-3.07) and a history of congestive heart failure (CHF)(OR 6.03, 95% CI, 1.82-20.03) were more likely to have a 'beneficial'TEE.

Conclusions CONCLUSIONS: The findings between TTE and TEE were discordant almost half of the time. TEE changed management in 15% of patients in our population. Patients ? 62years old and those with CHF were more likely to have a 'beneficial' TEE.

Authors/Disclosures
Justin M. DeLange, DO PRESENTER	No disclosure on file
Mark McDonald, MD (University of Virginia)	No disclosure on file
	No disclosure on file
	No disclosure on file
James C. Grotta, MD, FAAN (Memorial Hermann Hospital Life Flight)	Dr. Grotta has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Frazer Ltd. Dr. Grotta has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Haemonetics. Dr. Grotta has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Acticor. Dr. Grotta has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Prolong Pharma. Dr. Grotta has received publishing royalties from a publication relating to health care. Dr. Grotta has received publishing royalties from a publication relating to health care.
Eugenia Marzo	No disclosure on file
George A. Lopez, MD, PhD (Swedish Neuroscience Institute)	No disclosure on file
	No disclosure on file
Nicole Gonzales, MD (University of Colorado Anschutz Medical Campus)	The institution of Dr. Gonzales has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology.

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