Which patients should undergo tee after a stroke?

In as much as 40% of cerebrovascular events the source of emboli goes undetected. Transesophageal echocardiography (TEE) is often used to further identify potential sources of emboli such as aortic plaque. However, controversy exists as to which patients (pts) would have the greatest benefit from a TEE. Since aortic plaque is associated with hypertension (HTN) in autopsy studies, we postulate that stroke pts with HTN may have a higher incidence of aortic plaque. Therefore, we retrospectively collected demographic and risk factor data in 426 consecutive patients who underwent a biplane or multiplane TEE to exclude suspected cardiac source of emboli. 208 patients had complete risk factor data from the medical record and adequate aortic images on TEE. The TEE was interpreted for ascending aortic plaque without knowledge of clinical risk factors. Results: Non-mobile plaque (n=71) was more common than mobile plaque (n=11) in the ascending aorta, A stepwise multiple logistic regression model demonstrated that hypertension (p < 0.001), and age (p < 0.0001) were significantly linked to the development of atherosclerotic plaque. Diabetes, hyperlipidemia, tobacco use, gender, and family history were not related to aortic plaque. Conclusion: Older age and HTN independently increase the likelihood of finding atherosclerotic plaque in the ascending aorta. Since ascending aortic plaque is a potential source of emboli, these findings may allow improved selection of patients that should undergo TEE after stroke.