Echocardiography for the Detection of Cardiac Sources of Embolism in Patients with Stroke or Transient Ischemic Attack

Abstract

Transthoracic echocardiography (TTE) is commonly obtained during the evaluation of patients with ischemic stroke or transient ischemic attack (TIA) to detect potential sources of cardiogenic embolism. Specific indications for the tests remain uncertain. TTE and transesophageal echocardiography (TEE) use in routine clinical practice were assessed retrospectively in a consecutive series of patients with acute ischemic stroke to determine whether clinical features were useful in identifying those in whom echocardiography led to a change in patient evaluation or treatment. TTE identified a potential source of cardiogenic embolism in 35 of 186 (18.8%) patients, and led to a change in management in 10.8%, including anticoagulation or surgery in 5.4%. Of the 186 patients, 30 (16%) also had a TEE that identified a potential source of cardiogenic embolism in 18 (60.0%), with 33.3% subsequently having a change in evaluation or treatment. Changes in management based on TEE findings occurred in 44.4% of those with an abnormal TTE and 28.6% of those with a normal TTE. There was no association between patients' age, history of coronary heart disease, carotid stenosis, or stroke topology and the frequency of management-changing echocardiographic findings. TTE and TEE are useful for identifying management-changing potential sources of cardiogenic embolism in patients with acute ischemic stroke. Specific clinical factors increasing the yield of these tests as used in routine clinical practice, including stroke topology, could not be identified.