The role of echocardiography in cryptogenic stroke: a contemporary review.

Abstract

The role of echocardiography is critical in the diagnostic evaluation and management of ischemic stroke, especially cryptogenic stroke, in which the cause is unknown. About 15-30% of ischemic strokes are caused by cardiogenic embolism, making cardiac imaging a critical component of evaluation. Guidelines from the American Heart Association and the American College of Cardiology highlight the importance of echocardiography and mobile cardiac telemetry or implantable loop recorders to identify possible sources of cardiac embolism and monitor for atrial fibrillation, thus guiding secondary prevention.Transthoracic echocardiography (TTE) is widely used as an initial tool to assess cardiac structure and function, detect intracardiac thrombi, and evaluate valvular abnormalities. Transesophageal echocardiography (TEE), as well as cardiac CT and MRI, offer enhanced visualization of certain cardiac structures, identifying embolic sources not readily visible on TTE, such as left atrial appendage thrombi and patent foramen ovale (PFO).The comprehensive diagnostic approach for cryptogenic stroke (CS) includes brain imaging (CT or MRI), neurovascular imaging, electrocardiography (ECG), and vascular ultrasound.Echocardiography plays a crucial role in assessing left atrial and ventricular thrombi, valvular disease, and aortic plaques. Additionally, advancements in echocardiography, such as real-time three-dimensional imaging, are emphasized for their potential to enhance stroke prevention and management strategies.