Echocardiography and Stroke; A Narrative Review

Document Type : Review Article

Authors

1 Professor, Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Assistant Professor, Hypertension Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Evaluation of embolic stroke mechanism is an important diagnostic step in approaching patients with ischemic stroke (IS). Cardiogenic embolism has been estimated to be the causative factor in 15-30 percent of all IS; and near to 30% of patients with IS, are also embolic stroke undetermined source (ESUS). Various cardiac disorders including arrhythmias (atrial fibrillation), ventricular and arterial thrombus, valvular heart disease, cardiac tumors, endocarditis, structural atrial and ventricular defects, and atrial and ventricular cardiomyopathies can cause cardioembolic stroke. Although the aortic arch is not a cardiac structure, it is usually evaluated under source of cardiac. Transthoracic and transesophageal echocardiography are widely used diagnostic modalities for evaluation, diagnosis, and management of embolic stroke and ESUS, systemic and pulmonary embolism. This article reviews potential high- and low-risk cardiac sources of stroke, and discusses the role of both types of echocardiography in clinical practice.

Keywords


  1. Khorvash F, Khalili M, Rezvani HR, Sarafzadegan N, Givi M, Roohafza H, et al. Comparison of acute ischemic stroke evaluation and the etiologic subtypes between university and nonuniversity hospitals in Isfahan, Iran. Int J Stroke 2019; 14(6): 613-9.
  2. Saadatnia M, Zare M, Haghighi S, Tajmirriahi M, Hovsepian S. High frequency of IgM antiphospholipid antibodies in young Iranian patients with stroke. Neurosciences (Riyadh) 2007; 12(2): 124-6.
  3. Saric M, Armour AC, Arnaout MS, Chaudhry FA, Grimm RA, Kronzon I, et al. Guidelines for the use of echocardiography in the evaluation of a cardiac source of embolism. J Am Soc Echocardiogr 2016; 29(1): 1-42.
  4. Nakanishi K, Homma S. Role of echocardiography in patients with stroke. J Cardiol 2016; 68(2): 91-9.
  5. Tan BYQ, Ho JSY, Sia CH, Boi Y, Foo ASM, Dalakoti M, et al. Left atrial volume index predicts new-onset atrial fibrillation and stroke recurrence in patients with embolic stroke of undetermined source. Cerebrovasc Dis 2020; 49(3): 285-91.
  6. Sardana M, Lessard D, Tsao CW, Parikh NI, Barton BA, Nah G, et al. Association of left atrial function index with atrial fibrillation and cardiovascular isease: the Framingham offspring study. J Am Heart Assoc 2018; 7(7): e008435.
  7. Samiei N, Tajmirriahi M, Rafati A, Pasebani Y, Rezaei Y, Hosseini S. Pulmonary arterial pressure detects functional mitral stenosis after annuloplasty for primary mitral regurgitation: An exercise stress echocardiographic study. Echocardiography 2018; 35(2): 211-7.
  8. Saadatnia M, Salehi M, Movahedian A, Shariat SZ, Salari M, Tajmirriahi M, et al. Factor V Leiden, factor V Cambridge, factor II GA20210, and methylenetetrahydrofolate reductase in cerebral venous and sinus thrombosis: A case-control study. J Res Med Sci 2015; 20(6): 554-62.
  9. Laguna G, Arce N, Blanco M. Giant Chiari network, foramen ovale, and paradoxical embolism. Rev Esp Cardiol (Engl Ed) 2015; 68(3): 250.
  10. ElRefai M, Thananayagam K, Bathula R, Shah BN. An unusual cause of cardioembolic stroke: paradoxical embolism due to thrombus formation on the eustachian valve. Echocardiography 2015; 32(10): 1588-91.
  11. Ntaios G. Embolic stroke of undetermined source: JACC review topic of the week. J Am Coll Cardiol 2020; 75(3): 333-40.