Abstract P320: Impact of Inpatient TEE on Secondary Stroke Prevention

Abstract

Introduction: Transthoracic echocardiogram (TTE) is part of the standard stroke workup. If stroke remains cryptogenic after TTE and rest of the initial stroke evaluation, a transesophageal echocardiogram (TEE) is often performed. Evidence about when and in whom TEE should be done is lacking and reported effect on management vary widely. Our goal was to investigate the impact of TEE on stroke management. Methods: We performed a retrospective study of patients admitted with acute ischemic stroke (AIS) between April 2017 and December 2019 to a single, tertiary care, academic center. All patients received TTE and TEE while inpatient. Demographic data, clinical characteristics, results of echocardiograms and discharge medications were collected via chart review. Primary endpoint was change in stroke management based on TEE results. Secondary endpoint discovery of potential stroke etiology and factors associated with TEE results leading to change in management including age, multi-territory infarcts, TTE and vascular risk factors. We used Fisher’s Exact test and 2-sided Wilcoxon-Mann-Whitney rank-sum test. Results: We analyzed 92 patients with AIS who received both TTE and TEE. Median age was 56 (range 23-88), 51% were male and median NIHSS on admission was 9 (0-30). Middle cerebral artery infarct occurred in 58% and 32% had infarcts in multiple territories. Median hospital stay was 9 days (2-43). TEE revealed findings not seen on TTE in 52% and changed management in 16.3% of cases. Surprisingly, It appeared that older age was more likely to be associated with change of management based of TEE results (median age 61 vs. 55), as were multi-territory infarcts (46.7% vs 28.6%). However, neither of these results were statistically significant. Normal TTE findings were similar in both groups (60.0% vs 57.1%) and no vascular risk factors were associated with change of management based on TEE. Conclusion: TEE changes secondary stroke management in approximately one-sixth of patients and revealed new findings in about half. A larger study is needed to find factors associated with change in management based on TEE results.