Transoesophageal echo in elderly stroke patients

Transoesophageal echo (TOE) is increasingly used to detect the presence of a potential intracardiac source of embolism (SOE) in stroke patients. Due to the limited availability of TOE, however, this service is predominantly reserved for those younger stroke patients without other risk factors for stroke in whom an intracardiac SOE is deemed more likely. As stroke is predominantly a condition of the elderly, the majority of stroke patients are denied this service. This study aims to assess the usefulness of TOE in elderly stroke patients compared with a younger population. Method: 224 patients with either a cerebrovascular accident (CVA) or transient ischaemic attack (TIA) underwent TOE to determine the prevalence of potential intracardiac SOE. These include atrial septal aneurysm (ASA), patent foramen ovale (PFO), spontaneous echo contrast (SEC), valve strands & vegetations (Vegs), aortic atheroma, thrombus & tumours. 73 patients were aged ≥50 years, and 151 were aged over 50 years. Results: Overall TOE detected a potential intracardiac SOE in 184/224 (82%) of patients. 51/73 (70%) of those ≤50 years and 133/151 (88%) of patients >50 years had positive studies. With the exception of patent foramen ovale (PFO) all SOE were more prevalent in the elderly stroke population. In particular, the prevalence of aortic atheroma was much higher in the elderly (43% vs. 3%). Also, the prevalence of ASA, either alone or associated with a PFO, was considerably higher (23% vs. 8%) in the elderly. Age no ASA&PFO PFO ASA Strands Vegs SEC ≤50 73 8% 30% 0% 34% 0% 0% >50 151 15% 11% 9% 46% 1% 9% Age Mild-Mod Atheroma Severe Atheroma Thrombus Tumours ≤50 3% 0% 0% 1% >50 37% 6% 3% 2% Conclusions: TOE in elderly stroke patients has a high yield for potential intracardiac SOE, and further studies will be required to determine the relevance of these findings in the context of other risk factors for stroke. Many more such patients may be considered for referral for this investigation in the future.