Reproducibility of Transesophageal Echocardiography in Evaluating Aortic Atheroma in Stroke Patients

Although transesophageal echocardiography (TEE) is a well‐established tool in delineating the cardiac and aortic sources of emboli in stroke patients, its reproducibility in detecting aortic atherosclerosis (AA) that may lead to stroke is not well documented. The aim of this study is to demonstrate the inter‐ and intra‐observer agreement in diagnosing AA based on the TEE study. During the study period, 2 echocardiographers read 32 TEE studies performed on a group of stroke patients. The AA was estimated by measuring the largest atheroma thickness in millimeters (mm). The intra‐observers and intraclass correlation coefficients (ICC) were 0.97 and 0.85, respectively, for the 2 TEE observers. The inter‐rater ICC coefficient between TEE readers was 0.91. In conclusion, TEE detected AA and defined high proportions of the morphological characteristics of atheroma with good reproducibility among inter and intra‐observers.

[1]  C. Duyckaerts,et al.  The prevalence of ulcerated plaques in the aortic arch in patients with stroke. , 1992, The New England journal of medicine.

[2]  P. Sandercock,et al.  GEOGRAPHICAL AND SECULAR TRENDS IN STROKE INCIDENCE , 1987, The Lancet.

[3]  C. Tzourio,et al.  [Evaluation of aortic atherosclerosis by transesophageal echocardiography. Prognostic implications]. , 1997, Archives des maladies du coeur et des vaisseaux.

[4]  Lausanne , 2000 .

[5]  R. Hart,et al.  Cardiogenic embolism to the brain , 1992, The Lancet.

[6]  J. Kistler,et al.  Atherosclerotic disease of the aortic arch and the risk of ischemic stroke. , 1995, The New England journal of medicine.

[7]  F. Cárdenas.  [Protruding plaques of the thoracic aorta in the transesophageal echocardiogram: clinical and echographic characteristics]. , 1996, Revista medica de Chile.

[8]  J. Serena,et al.  Atherosclerotic Aortic Arch Plaques in Cryptogenic Stroke: A Microembolic Signal Monitoring Study , 2001, European Neurology.

[9]  Daniel B Hier,et al.  Brain infarction severity differs according to cardiac or arterial embolic source , 1993, Neurology.

[10]  Daniel B Hier,et al.  Infarcts of undetermined cause: The NINCDS stroke data bank , 1989, Annals of neurology.

[11]  E. Acarturk,et al.  Detection of aortic plaques by transesophageal echocardiography in patients with ischemic stroke , 1995, Acta neurologica Scandinavica.

[12]  D. Reich,et al.  The Ascending Aorta: How Much Does Transesophageal Echocardiography See? , 1994, Anesthesia and analgesia.

[13]  J. R. Landis,et al.  An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. , 1977, Biometrics.

[14]  E. Loeliger.  Cardiogenic embolism to the brain , 1992, The Lancet.

[15]  ChristopheTzourio,et al.  Aortic Plaque Morphology and Vascular Events , 1997 .

[16]  J. Weinberger,et al.  Natural history of aortic arch atherosclerotic plaque , 2000, Neurology.

[17]  G. Plotnick,et al.  Ulcerated atherosclerotic plaques in the thoracic aorta are associated with cryptogenic stroke: a multiplane transesophageal echocardiographic study. , 1995, American heart journal.

[18]  L. Valton,et al.  Asymptomatic cerebral embolic signals in patients with acute cerebral ischaemia and severe aortic arch atherosclerosis , 2001, Journal of Neurology.

[19]  I. Kronzon,et al.  The Improved Yield of Transesophageal Echocardiography Over Transthoracic Echocardiography in Patients with Neurological Events is Largely Due to the Detection of Aortic Protruding Atheromas , 1992, Echocardiography.

[20]  A. Labovitz,et al.  Mobile aortic atheroma and systemic emboli: efficacy of anticoagulation and influence of plaque morphology on recurrent stroke. , 1998, Journal of the American College of Cardiology.

[21]  R. Sacco,et al.  Atherosclerotic disease of the aortic arch as a risk factor for recurrent ischemic stroke. , 1996, The New England journal of medicine.

[22]  C. Tzourio,et al.  Aortic plaque morphology and vascular events: a follow-up study in patients with ischemic stroke. FAPS Investigators. French Study of Aortic Plaques in Stroke. , 1997, Circulation.

[23]  D. Altman,et al.  Comparing methods of measurement: why plotting difference against standard method is misleading , 1995, The Lancet.

[24]  E. Ferrari,et al.  Atherosclerosis of the thoracic aorta and aortic debris as a marker of poor prognosis: benefit of oral anticoagulants. , 1999, Journal of the American College of Cardiology.

[25]  T Moulin,et al.  Atherosclerotic disease of the aortic arch as a risk factor for recurrent ischemic stroke. , 1996, The New England journal of medicine.

[26]  P. Amarenco,et al.  Evaluation de l'athérosclérose aortique par échocardiographie transoesophagienne : Implications pronostiques , 1997 .

[27]  F. Chaudhry,et al.  Usefulness of complex atherosclerotic plaque in the ascending aorta and arch for predicting cardiovascular events. , 2002, The American journal of cardiology.

[28]  B. Shively.  Transesophageal echocardiography in the diagnosis of aortic disease. , 1993, Seminars in ultrasound, CT, and MR.

[29]  J. Bogousslavsky,et al.  The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke. , 1988, Stroke.