{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T12:31:46Z","timestamp":1765888306190,"version":"3.44.0"},"reference-count":21,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2020,3,23]],"date-time":"2020-03-23T00:00:00Z","timestamp":1584921600000},"content-version":"unspecified","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007282","name":"Baylor Health Care System Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007282","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2020,2,24]]},"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>The role of transoesophageal echocardiography (TOE) in identifying ischaemic stroke aetiology is debated. In 2018, the American Heart Association\/American Stroke Association (AHA\/ASA) issued class IIa recommendation for echocardiography, with the qualifying statement of use in cases where it will alter management. Hence, we sought to determine the rate at which TOE findings altered management in cases of confirmed ischaemic stroke.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We retrospectively analysed TOE cases with confirmed ischaemic stroke at our centre between April 2015 and February 2017. We defined a change in management as the initiation of anticoagulation therapy, antibiotic therapy or patent foramen ovale closure as a direct result of TOE findings.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There were 185 patients included in this analysis; 19 (10%) experienced a change in management. However, only 7 of the 19 (4% of all subjects) experienced a change in management due to TOE findings. The remaining 12 were initiated on oral antigoagulation as a result of discoveries during routine workup, mainly atrial fibrillation on telemetry monitoring.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This work suggests an overuse of TOE and provides support for the 2018 AHA\/ASA stroke guidelines, which recommend against the routine use of echocardiography in the work up of cerebrovascular accident due to a cardioembolic source.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2019-001176","type":"journal-article","created":{"date-parts":[[2020,3,24]],"date-time":"2020-03-24T15:44:35Z","timestamp":1585064675000},"page":"e001176","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Limitations of transoesophageal echocardiogram in acute ischaemic stroke"],"prefix":"10.1136","volume":"7","author":[{"given":"Zachary P","family":"Rosol","sequence":"first","affiliation":[{"name":"Department of Cardiology, Baylor University Medical Center at Dallas, Dallas, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen F","family":"Kopecky","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Baylor University Medical Center at Dallas, Dallas, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bailey R","family":"Minehart","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Baylor University Medical Center at Dallas, Dallas, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6732-8698","authenticated-orcid":false,"given":"Kristen M","family":"Tecson","sequence":"additional","affiliation":[{"name":"Baylor Heart and Vascular Institute, Baylor Scott & White Research Institute, Dallas, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anupama","family":"Vasudevan","sequence":"additional","affiliation":[{"name":"Baylor Heart and Vascular Institute, Baylor Scott & White Research Institute, Dallas, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter A","family":"McCullough","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Baylor University Medical Center at Dallas, Dallas, Texas, USA"},{"name":"Department of Cardiology, The Baylor Scott & White Heart and Vascular Hospital - Dallas, Dallas, TX, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul A","family":"Grayburn","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Baylor University Medical Center at Dallas, Dallas, Texas, USA"},{"name":"Department of Cardiology, The Baylor Scott & White Heart and Vascular Hospital - Dallas, Dallas, TX, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3446-2129","authenticated-orcid":false,"given":"Jeffrey M","family":"Schussler","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Baylor University Medical Center at Dallas, Dallas, Texas, USA"},{"name":"Department of Cardiology, The Baylor Scott & White Heart and Vascular Hospital - Dallas, Dallas, TX, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,3,24]]},"reference":[{"key":"2025081612213268000_7.1.e001176.1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000350"},{"key":"2025081612213268000_7.1.e001176.2","doi-asserted-by":"publisher","DOI":"10.1161\/hs1201.100209"},{"key":"2025081612213268000_7.1.e001176.3","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000158"},{"key":"2025081612213268000_7.1.e001176.4","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.24.1.35"},{"key":"2025081612213268000_7.1.e001176.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2015.09.011"},{"key":"2025081612213268000_7.1.e001176.6","doi-asserted-by":"publisher","DOI":"10.2174\/157340310791658721"},{"key":"2025081612213268000_7.1.e001176.7","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000202592.87021.b7"},{"key":"2025081612213268000_7.1.e001176.8","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.551226"},{"key":"2025081612213268000_7.1.e001176.9","doi-asserted-by":"crossref","unstructured":"Schwartz BG , Chris Alexander MD , MD Paul A. Grayburn, MD , et al . Utility of routine transesophageal echocardiography in patients with stroke or transient ischemic attack utility of routine transesophageal echocardiography in patients with stroke or transient ischemic attack Brian G. Schwartz, MD 2, Chris Alexander. . Baylor Univ Med Cent Proc 2018. f..","DOI":"10.1080\/08998280.2018.1471935"},{"key":"2025081612213268000_7.1.e001176.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.03.011"},{"key":"2025081612213268000_7.1.e001176.11","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1111\/echo.13131","article-title":"Diagnostic impact of transesophageal echocardiography in patients with acute cerebral ischemia","volume":"33","author":"Pallesen","year":"2016","journal-title":"Echocardiography"},{"key":"2025081612213268000_7.1.e001176.12","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1212\/WNL.0000000000003063","article-title":"The value of transesophageal echocardiography for embolic strokes of undetermined source","volume":"87","author":"Katsanos","year":"2016","journal-title":"Neurology"},{"key":"2025081612213268000_7.1.e001176.13","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1002\/jhm.2484","article-title":"Impact of transesophageal echocardiography on clinical management of patients over age 50 with cryptogenic stroke and normal transthoracic echocardiogram","volume":"11","author":"Marino","year":"2016","journal-title":"J Hosp Med"},{"key":"2025081612213268000_7.1.e001176.14","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(17)30002-9"},{"key":"2025081612213268000_7.1.e001176.15","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1313600"},{"key":"2025081612213268000_7.1.e001176.16","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1311376"},{"key":"2025081612213268000_7.1.e001176.17","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1215340"},{"key":"2025081612213268000_7.1.e001176.18","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)16721-4"},{"key":"2025081612213268000_7.1.e001176.19","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa060989"},{"key":"2025081612213268000_7.1.e001176.20","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.113.002590"},{"key":"2025081612213268000_7.1.e001176.21","doi-asserted-by":"crossref","first-page":"23","DOI":"10.5853\/jos.2018.03097","article-title":"Patent foramen ovale: story closed?","volume":"21","author":"K\u00f6hrmann","year":"2019","journal-title":"J Stroke"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2019-001176","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,16]],"date-time":"2025-08-16T19:21:38Z","timestamp":1755372098000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2019-001176"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3]]},"references-count":21,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,3,24]]},"published-print":{"date-parts":[[2020,3]]}},"alternative-id":["10.1136\/openhrt-2019-001176"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2019-001176","relation":{},"ISSN":["2053-3624"],"issn-type":[{"type":"electronic","value":"2053-3624"}],"subject":[],"published":{"date-parts":[[2020,3]]}}}