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Original research
Limitations of transoesophageal echocardiogram in acute ischaemic stroke
  1. Zachary P Rosol1,
  2. Kathleen F Kopecky1,
  3. Bailey R Minehart1,
  4. Kristen M Tecson2,
  5. Anupama Vasudevan2,
  6. Peter A McCullough1,3,
  7. Paul A Grayburn1,3 and
  8. Jeffrey M Schussler1,3
  1. 1Department of Cardiology, Baylor University Medical Center at Dallas, Dallas, Texas, USA
  2. 2Baylor Heart and Vascular Institute, Baylor Scott & White Research Institute, Dallas, Texas, USA
  3. 3Department of Cardiology, The Baylor Scott & White Heart and Vascular Hospital - Dallas, Dallas, TX, United States
  1. Correspondence to Dr Jeffrey M Schussler, Department of Cardiology, Baylor University Medical Center, Dallas, TX, United States; jeffrey.schussler{at}


Objective The role of transoesophageal echocardiography (TOE) in identifying ischaemic stroke aetiology is debated. In 2018, the American Heart Association/American Stroke Association (AHA/ASA) issued class IIa recommendation for echocardiography, with the qualifying statement of use in cases where it will alter management. Hence, we sought to determine the rate at which TOE findings altered management in cases of confirmed ischaemic stroke.

Methods We retrospectively analysed TOE cases with confirmed ischaemic stroke at our centre between April 2015 and February 2017. We defined a change in management as the initiation of anticoagulation therapy, antibiotic therapy or patent foramen ovale closure as a direct result of TOE findings.

Results There were 185 patients included in this analysis; 19 (10%) experienced a change in management. However, only 7 of the 19 (4% of all subjects) experienced a change in management due to TOE findings. The remaining 12 were initiated on oral antigoagulation as a result of discoveries during routine workup, mainly atrial fibrillation on telemetry monitoring.

Conclusions This work suggests an overuse of TOE and provides support for the 2018 AHA/ASA stroke guidelines, which recommend against the routine use of echocardiography in the work up of cerebrovascular accident due to a cardioembolic source.

  • stroke
  • echocardiography
  • transoesophageal
  • anticoagulation

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  • Contributors ZPR contributed to the design, interpretation and draft. KFK, BRM, KMT and AV contributed to data acquisition and critical revision. PAM, PAG and JMS contributed to interpretation and critical revision. All authors approve and agree to be accountable of this work.

  • Funding This work was partially funded by the Baylor Heath Care System Foundation.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This retrospective study was approved by the Baylor Scott & White Research Institute’s Institutional Review Board with a waiver of informed consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data from this study will not be made available.

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