Abstract TP220: Utility of Transthoracic Echocardiography in the Evaluation of Acute Stroke and TIA

Abstract

Background: Transthoracic echocardiography (TTE) is widely employed in the evaluation of acute ischemic stroke (AIS) and transient ischemic attack (TIA). However, there is no consensus on its utility. We aim to determine the diagnostic and therapeutic value of TTE in AIS and TIA. Methods: We retrospectively reviewed 359 charts of patients with a diagnosis of AIS or TIA. TTE was performed on 322/359 patients. The results were separated into 3 categories: 1) no major abnormality; 2) findings with no definitive intervention required: ejection fraction <40% , left atrial size >4.0 cm, patent foramen ovale with or without atrial septal defect, left ventricular thrombus or enlarged left atrium with mitral valve disease; 3) findings necessitating intervention: left atrial thrombus, left atrial myxoma, or valvular vegetations. Interventions were defined as initiation of anticoagulation, antibiotics or valvular surgery for myxomas. Results: Of 359 patients, 251 had AIS and 108 had TIA. TTE was performed in 229/251 patients with AIS and 93/108 patients with TIA. The frequencies of category 1, 2 and 3 findings were 63/93 (67.7%), 29/93 (31.2%), 1/93 (1.1%), respectively in TIA group and 109/229 (47.6%), 117/229 (51.1%), 3/229 (1.3%), respectively in AIS group. In the AIS cohort, 3/3 patients (100%) with category 3 findings (2 cases of valvular vegetations and 1 case of cardiac myxoma) and only 7/117 (6.0%) patients with category 2 findings had a change in management. In the TIA cohort, 2/29 (6.9%) patients with category 2 findings (1 case of left ventricular thrombus and 1 case of low ejection fraction) had a change in management and the single patient with category 3 finding had a left atrial appendage thrombus who was inadequately anticoagulated, thus no new therapy was begun. Conclusion: TTE has a modest yield in acute cerebrovascular disease. While it provides useful information, it seldom (in only 1.7% of cases) provides data that unequivocally necessitates a therapeutic intervention in patients with AIS. Given low yield of TTE among TIA patients, it may be reasonable to obtain TTE after hospital discharge. In summary, a better mechanism is needed to identify, prior to the performance of TTE, a cohort of AIS and TIA patients in whom the TTE findings will definitively alter care.