Comparing Multislice Electrocardiogram-gated Spiral Computerized Tomography and Transesophageal Echocardiography in Evaluating Aortic Atheroma in Patients with Acute Ischemic Stroke

Hussain, Syed I.; Gilkeson, Robert C.; Suarez, Jose I.; Tarr, Robert; Schluchter, Mark; Landis, Dennis M.D.; Zaidat, Osama O.

doi:10.1016/j.jstrokecerebrovasdis.2007.12.008

« Previous Next »Journal of Stroke & Cerebrovascular Diseases
Volume 17, Issue 3 , Pages 134-140, May 2008

Comparing Multislice Electrocardiogram-gated Spiral Computerized Tomography and Transesophageal Echocardiography in Evaluating Aortic Atheroma in Patients with Acute Ischemic Stroke

Syed I. Hussain, MD
- Department of Neurology, Medical College of Wisconsin/Froedtert Hospital, Milwaukee, Wisconsin
Robert C. Gilkeson, MD
- Department of Radiology, Case Medical School, Cleveland, Ohio
Jose I. Suarez, MD
- Department of Neurology, Baylor College of Medicine, Houston, Texas
Robert Tarr, MD
- Department of Radiology, Case Medical School, Cleveland, Ohio
Mark Schluchter, PhD
- Department of Epidemiology and Biostatistics, Case Medical School, Cleveland, Ohio
Dennis M.D. Landis, MD
- Department of Neurology, Baylor College of Medicine, Houston, Texas
Osama O. Zaidat, MD, MS
- Department of Neurology, Medical College of Wisconsin/Froedtert Hospital, Milwaukee, Wisconsin
- Address correspondence to Osama O. Zaidat, MD, MS, Neurology and Neurosurgery, Medical College of Wisconsin/Froedtert Hospital, 9200 W Wisconsin Ave, Milwaukee, WI 53226.

Received 13 September 2007; received in revised form 9 December 2007; accepted 19 December 2007.

Objective

The aim of this study was to compare transesophageal echocardiography (TEE) and cardiac-gated computerized tomography (CGCT) in detecting aortic atherosclerosis (AA).

Background

There is evidence that AA can be a source of embolic material causing ischemic stroke. TEE is a well-established tool for detecting cardiac sources of emboli in patients with stroke, but it has distinct limitations in the detection of AA.

Method

This was a prospective study of patients admitted with the diagnosis of ischemic stroke between February and November of 2000. Among this cohort are patients who underwent both TEE and CGCT for the evaluation of stroke cause. The CGCT studies were retrieved and interpreted by a radiologist with special expertise in chest tomography, and TEE studies were read by an echocardiographer with special expertise in reading and performing TEE. The interpreters were unaware of the results obtained by the other. The AA was estimated by measuring atheroma thickness in millimeters. The relations between the two tests were analyzed graphically using Bland-Altman, and Pollock plots. Results from Pearson (r), Spearman (r_s), and intraclass correlation tests were also estimated.

Results

The aortic atheroma thickness in millimeters was compared between CGCT and TEE in 32 patients, who underwent both studies. The intraclass correlation was 0.93, with high correlation (r = 082, r_s = 0.83). CGCT detected smaller AA more often, and provided more information about the shape of atheromatous plaques.