TY - JOUR T1 - Limitations of transoesophageal echocardiogram in acute ischaemic stroke JF - Open Heart JO - Open Heart DO - 10.1136/openhrt-2019-001176 VL - 7 IS - 1 SP - e001176 AU - Zachary P Rosol AU - Kathleen F Kopecky AU - Bailey R Minehart AU - Kristen M Tecson AU - Anupama Vasudevan AU - Peter A McCullough AU - Paul A Grayburn AU - Jeffrey M Schussler Y1 - 2020/03/01 UR - http://openheart.bmj.com/content/7/1/e001176.abstract N2 - 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. ER -