Abstract W P196: Utility of Echocardiography in the Evaluation of Transient Ischemic Attack Patients

Abstract

Background: Current guidelines recommend that patients presenting with transient ischemic attack (TIA) undergo echocardiography to evaluate for a cardiac source. The aim of this study was to determine the utility of transthoracic echocardiography (TTE) in TIA patients evaluated as part of an emergency department observation unit (EDOU) protocol. Methods: Prospectively identified TIA patients presenting to the Emory University Hospital EDOU from January 1, 2011 to July 31, 2013 were eligible for this analysis if they had a final discharge diagnosis of TIA. Baseline patient characteristics, diagnostic test results, and clinical outcome at 3 months were retrospectively collected. An abnormal TTE was defined as an ejection fraction (EF) ≤ 45%, significant regional wall motion (RWM) abnormality, significant diastolic dysfunction (DD), valvular mass, presence of clot, or positive bubble study. Results: Of 236 patients discharged with a diagnosis of TIA during the study period, mean age was 62 ±15 years, 68% were female, 57% were African American, 17% had a history of prior stroke, 27% had history of cardiac disease, and mean ABCD2 score was 3.8 ±1.5. Overall, 19 (8%) patients had an abnormal bedside cardiac exam, 44 (19%) patients had an abnormal ECG, and 51 (22%) patients had an abnormal TTE including 18 with EF ≤ 45%, 6 with significant RWM abnormality, 9 with significant DD, 2 with clot, and 32 with positive bubble study; no valvular masses were seen. At 3 months, there was no significant difference in outcomes among patients with and without abnormalities on TTE (stroke 1.5% vs 1.8%, p=1.0; myocardial infarction 0 vs 1.2%, p=1.0). Among the 125 patients with no history of stroke or coronary artery disease and normal cardiac exam and ECG, TTE identified 5 (4%) patients with EF ≤ 45%, 17 (14%) patients with positive bubble study and no patients with significant RWM abnormalities, diastolic dysfunction, valvular mass, or clot; at 3 months, 2 (1.6%) of these patients had a stroke and no patients had a myocardial infarction. Conclusion: Among TIA patients with no history of stroke or coronary artery disease, normal cardiac exam, and normal ECG, TTE has a low yield.