经食管超声心动图在心源性卒中病因筛查中的价值OA

Objective To evaluate the value of transesophageal echocardiography(TEE)combined with contrast-enhanced TEE in the etiological screening of cardioembolic stroke. Methods This prospective study consecutively enrolled patients with clinically suspected cardioembolic stroke who were admitted to the Beijing Tiantan Hospital,Capital Medical University,between March 2023 and May 2025.All enrolled patients underwent routine transthoracic echocardiography(TTE)and TEE examinations.Among them,patients with atrial fibrillation underwent left heart contrast enhanced-TEE(LHCE-TEE),and patients with right-to-left shunt(RLS)indicated by TCD underwent agitated saline contrast enhanced-TEE(ASCE-TEE).The observed indicators included intracardiac and atrial appendage thrombi,the source and grade of RLS,prosthetic valve thrombus,and aortic arch plaque condition. Results A total of 256 patients with suspected cardioembolic stroke were enrolled,including 80 patients with atrial fibrillation,150 patients with RLS,and 26 patients with other etiologies.Among the 80 patients with atrial fibrillation,16 patients were diagnosed with left atrial appendage thrombi.The initial examination results showed that the number of left atrial appendage thrombi detected by TTE,TEE,and LHCE-TEE was 1,8,and 16,respectively.LHCE-TEE was superior to TEE in detecting hypoechoic thrombi(9 cases vs.1 case,P＜0.01)and non-active thrombi(9 cases vs.1 case,P＜0.01).Among the 150 patients with RLS,ASCE-TEE detected more cases of patent foramen ovale(PFO)(125 cases)than TTE(15 cases)and TEE(65 cases)and was able to identify smaller PFOs,with statistically significant differences(both P＜0.01).ASCE-TEE detected 125 cases of PFO-RLS,55 cases of pulmonary vein-related RLS(P-RLS),and 45 cases with both PFO-RLS and P-RLS.Semiquantitative analysis of RLS showed that the proportion of patients with grade 3 shunt volumes was higher than that with grade 1 and 2 shunt volumes in both PFO-RLS and P-RLS(both P＜0.05).Additionally,TTE demonstrated a higher detection rate for left ventricular thrombi than TEE(12 cases vs.8 cases),while TEE outperformed TTE in detecting prosthetic valve thrombi(6 cases vs.1 case)and unstable aortic arch and/or descending aortic plaques(25 cases vs.10 cases). Conclusions LHCE-TEE can clearly delineate the borders of hypoechoic left atrial appendage thrombi and significantly improve the detection rate of hypoechoic and non-active thrombi.ASCE-TEE accurately identifies PFO and effectively differentiates the source and grade of RLS.TEE has important clinical value in detecting prosthetic valve thrombi,unstable aortic arch and/or descending aortic plaques.