ASE Guidelines and Standards
Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism

https://doi.org/10.1016/j.echo.2015.09.011Get rights and content

Embolism from the heart or the thoracic aorta often leads to clinically significant morbidity and mortality due to transient ischemic attack, stroke or occlusion of peripheral arteries. Transthoracic and transesophageal echocardiography are the key diagnostic modalities for evaluation, diagnosis, and management of stroke, systemic and pulmonary embolism. This document provides comprehensive American Society of Echocardiography guidelines on the use of echocardiography for evaluation of cardiac sources of embolism.

It describes general mechanisms of stroke and systemic embolism; the specific role of cardiac and aortic sources in stroke, and systemic and pulmonary embolism; the role of echocardiography in evaluation, diagnosis, and management of cardiac and aortic sources of emboli including the incremental value of contrast and 3D echocardiography; and a brief description of alternative imaging techniques and their role in the evaluation of cardiac sources of emboli.

Specific guidelines are provided for each category of embolic sources including the left atrium and left atrial appendage, left ventricle, heart valves, cardiac tumors, and thoracic aorta. In addition, there are recommendation regarding pulmonary embolism, and embolism related to cardiovascular surgery and percutaneous procedures. The guidelines also include a dedicated section on cardiac sources of embolism in pediatric populations.

Keywords

Cardioembolism
Cryptogenic stroke
Cardiac mass
Cardiac tumor
Cardiac shunt
Vegetation
Prosthetic valve
Aortic atherosclerosis
Intracardiac thrombus

Abbreviations

2D
Two-dimensional
3D
Three-dimensional
ASA
Atrial septal aneurysm
ASD
Atrial septal defect
ASE
American Society of Echocardiography
ATS
Aortic thromboembolism syndrome
AVM
Arteriovenous malformation
CES
Cholesterol emboli syndrome
CT
Computed tomography
IE
Infective endocarditis
LA
Left atrium
LAA
Left atrial appendage
LV
Left ventricle
MAC
Mitral annular calcification
MRI
Magnetic resonance imaging
MV
Mitral valve
NBTE
Nonbacterial thrombotic endocarditis
PE
Pulmonary embolism
PFE
Papillary fibroelastoma
PFO
Patent foramen ovale
PLAX
Parasternal long-axis
PSAX
Parasternal short axis
RA
Right atrium
RV
Right ventricle
SEC
Spontaneous echocardiographic contrast
TAVR
Transcatheter aortic valve replacement
TCD
Transcranial Doppler
TEE
Transesophageal echocardiography
TIA
Transient ischemic attack
TTE
Transthoracic echocardiography
VSD
ventricular septal defect

Cited by (0)

The following authors reported no actual or potential conflicts of interest in relation to this document: Muhamed Saric, MD, PhD, FASE, Chair, Alicia Armour, MA, BS, RDCS, FASE, M. Samir Arnaout, MD, Richard A. Grimm, DO, FASE, Bruce F. Landeck, II, MD, FASE, Hector Michelena, MD, FASE, and Kirsten Tolstrup, MD, FASE. The following authors reported relationships with one or more commercial interests: Farooq Chaudhry, MD, FASE serves as a consultant for Lantheus Medical Imaging and received grant support from GE Healthcare and Bracco. Itzhak Kronzon, MD, FASE, serves as a consultant for Philips Healthcare; Kameswari Maganti, MD, FASE, received a research grant from GE Healthcare.

Reprint requests: American Society of Echocardiography, 2100 Gateway Centre Boulevard, Suite 310, Morrisville, NC 27560 (E-mail: [email protected]).

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