Impact of transesophageal echocardiogram findings on management of acute ischemic stroke: a retrospective single-institution cohort study.

Background: Physicians use transesophageal echocardiography (TEE) as part of the workup for acute ischemic stroke; however, its importance is controversial. While its clinical utility in this patient population may seem logical, based on current data and guideline recommendations, there is no empirical recommendation for using TEE over a transthoracic echocardiogram (TTE). This study aimed to provide an update on the TEE's impact on the clinical outcomes of patients with acute stroke. Methods: We conducted a retrospective single-institution cohort study at a tertiary care hospital from June 2021 to August 2022 for patients admitted with new-onset ischemic stroke with or without hemorrhagic conversion who subsequently had a TEE completed at the same admission or after discharge. The primary outcome was the detection of management changes based on TEE results, while secondary outcomes included positive findings leading to embolic stroke, the feasibility of performing TEE as an inpatient versus outpatient procedure, and the TTE yield compared to TEE. Results: A total of 176 patients underwent TEE to investigate the cause of stroke. The mean age of those with positive TEE findings was 65.5 years versus 66 years for those with negative or irrelevant findings. Positive TEE patients were 47.7% female versus 45% in the negative finding group. Both age and sex comparisons did not yield statistically significant differences ( Conclusion: In patients with newly diagnosed stroke, TEE provided high diagnostic values and impacted the management of 23.9 % of all patients who underwent the test. These findings support its continued use in diagnostic workups, with a higher diagnostic yield than the transthoracic approach.