Abstract 5505: The Impact of Selectively Performed Echocardiography in Patients With Acute Ischemic Stroke or Transient Ischemic Attack
Background: The updated ACC/AHA/ASE guideline in 2003 recommended that echocardiography be performed selectively in patients with acute ischemic stroke or TIA. We aimed to evaluate the diagnostic yield and therapeutic impact of transthoracic echocardiography (TTE) with such an approach.
Methods: A total of 984 consecutive patients with acute ischemic stroke or TIA were included in the study. Clinical data were systemically reviewed, including the reports of ECG, brain MRI/CT and carotid duplex ultrasound (CDUS). TTE data were retrospectively analyzed.
Results: TTE tests were performed in 624 (63.4%) patients (mean age 70.9±14.1 years, 47.4% of men). Atrial fibrillation (AF) was present in 116 (18.6%) patients. An overall potential cardiac source of embolism (PCSE) was found in 155 (24.8%). Atrial septal abnormality (PFO± septal aneurysm) and LV dysfunction (EF ≤ 30%± wall motion abnormality/LV aneurysm) were the most frequent PCSE in younger (< 45 years) and older (≥ 45 years) patients, respectively. The overall diagnostic yield of TTE was comparable in both groups (35.5% vs 26.8%, P = 0.303). Significant carotid stenosis was found in 27 (7.5%) patients in the older group by CDUS, but none in the younger patients. After excluding patients with AF and significant carotid stenosis, who have independent indication for anticoagulation or intervention, the therapeutic impact of TTE was more significant in younger patients (27.6% vs 11.5%, P = 0.019). Numbers needed to test (NNT) for detection of a PCSE was 4 in younger patients and 9 in older patients, the latter being more than 2-fold of the former.
Conclusion: Selectively performed TTE in patients with ischemic stroke or TIA can provide important information on PCSE. The diagnostic yield and therapeutic impact are much higher in younger patients.