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Review
. 2025 Aug 26:1-11.
doi: 10.1080/14796678.2025.2550896. Online ahead of print.

The role of echocardiography in cryptogenic stroke: a contemporary review

Aimen Shafiq  1 , Aveen Salar  2 , Bourann Husainy  2 , George G Kidess  2 , Kaksha Parrikh  3 , Jawad Basit  4 , Wael Al Jaroudi  5 , M Chadi Alraies  6
Affiliations
Review

The role of echocardiography in cryptogenic stroke: a contemporary review

Aimen Shafiq et al. Future Cardiol. .

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.

Keywords: Echocardiography; cardiac imaging; patent foramen ovale; radiological approaches; stroke.

Plain language summary

A stroke happens when blood flow to part of the brain is blocked. In many cases, the cause is a blocked blood vessel or an irregular heartbeat. But in about one out of three strokes, the cause is unknown. These are called cryptogenic strokes. This article explains how heart ultrasound tests can help find possible causes of these strokes. There are two main types: 1. Transthoracic echocardiography (TTE): done by placing a probe on the chest. 2. Transesophageal echocardiography (TEE): done by gently passing a probe down the throat into the food pipe for a clearer view of the heart. These tests can detect issues such as blood clots, heart valve problems, or a small hole between the heart’s chambers. Finding these problems is important because they may increase the risk of having another stroke. The article also talks about newer imaging tools, like cardiac MRI and CT scans, which can give even more detailed pictures of the heart when needed. By using a mix of tests and heart scans, physicians can better understand why a cryptogenic stroke happened and decide the best way to prevent another one.

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