ECHO 2013 / Advanced TEE Clinical Decision Making in Cryptogenic Stroke and Atrial Fibrillation
.pdf
Advanced TEE: Clinical Decision Making in Cryptogenic Stroke and Atrial Fibrillation
Marco R. Di Tullio, M.D
Professor of Medicine
Associate Director, Cardiovascular Ultrasound Laboratories
Columbia University Medical Center, New York
FINANCIAL DISCLOSURE: None
Effect of Reclassification of Infarcts of Undetermined Cause on Distribution of Cerebral Infarcts Subtype
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% 45 |
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Actual |
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Projected |
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Atherosclerotic Lacunar Cardioembolic Cryptogenic
TEE vs. TTE in Cryptogenic Stroke
•In 231 patients with cryptogenic stroke or TIA, a potential source of embolism was observed in 55% by TEE and in 16% by TTE (+39%)
•A major risk factor (with an absolute indication to anticoagulation) was seen in 20% of patients by TEE vs. 4% by TTE (+16%)
•The difference in proportions of cardiac sources detected existed in both patients below or above the age of 45 years
de Bruijn et al, Stroke 2006, 37:2531-4
Patent Foramen Ovale (PFO)
2D and Color Doppler
Patent Foramen Ovale (PFO)
Contrast study
PFO and Cryptogenic Stroke
PFO and Cryptogenic Stroke
PFO Prevalence - Autopsy
PFO and Stroke in the General Population –
NOMAS (N=1100)
1.0
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0.9 |
free Probability |
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Event- |
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0.7 |
0.6
0
Logrank test p = 0.298
PFO+ (n=164)
PFO- (n=936)
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Time to event (months)
Di Tullio et al, J Am Coll Cardiol 2007;52:855-61