Abstract WP255: The Role of Echocardiography and ECG in Stroke Patients

Abstract

Background: The cardiac diagnostic workup of stroke patients, especially the value of echocardiography and prolonged and enhanced Holter-ECG monitoring (EPM), is still a matter of debate. We aimed to analyse the impact of pathologies detected by echocardiography and ECG monitoring on therapeutic decisions and prognosis. Methods: Find-AF RANDOMISED was a prospective multicenter study which randomised 398 acute ischemic stroke patients ≥ 60 years to EPM or usual stroke unit care. Therapeutic consequences of echocardiography and routine Holter-ECG or EPM, respectively, were compared and one-year mortality was calculated. Results: 50.3% received EPM and 49.7% routine ECG monitoring. 82.9 % underwent transthoracic echocardiography (TTE), 38.9 % transesophageal echocardiography (TEE) and 25.6 % both procedures. 14/90 TEE pathologies and 1/89 TTE pathology led to a change in therapy, resulting in a number needed to change decision (NNCD) of 12 and 334, respectively. In comparison, EPM found atrial fibrillation (AF) in 27 of 200 patients, and routine ECG monitoring in twelve of 198 patients, leading to therapeutic changes in all patients (NNCD 8 and 17, respectively). We found a trend towards a higher one-year mortality in patients with pathologic echocardiographic findings (p = 0.093). Conclusions: Most changes in therapeutic decisions were caused by EPM, which should therefore play a more prominent role in future guidelines. Echocardiography identifies a patient group at high cardiovascular risk, but rarely result in therapeutic changes. Whether this patient group requires further cardiovascular workup remains unknown. This should be further investigated by interdisciplinary neurocardiologic teams and in appropriate future trials.