Abstract
Objective: Transthoracic echocardiography (TTE) is routinely performed as part of standard acute ischemic stroke (AIS) workup. However, the overall yield of TTE is unclear and many patients may undergo unnecessary investigations. This study aims to investigate the utility of TTE as part of AIS workup.Methods: We collected data on consecutive patients with AIS who were admitted to our institution between 07/01/2016 and 09/30/2017. Patients were included based on neuroimaging-documented AIS, age >18 and neuroimaging studies. Primary endpoint was the proportion of cases in which TTE yielded relevant finding, defined as Atrial Septa Defect or Patent Foramen Ovale, left atrial enlargement, left ventricular thrombus or ejection fraction of <35%. Secondary endpoint was the proportion of patients who had a TTE-drive change in management.Results: Among 548 AIS patients (median age 71 [59–81] years, 50% female), 482 (87%) underwent TTE. Clinically relevant findings were observed in 183 (38%) patients, leading to additional workup in 41 (8.5%). Further workup was associated with younger median age (58 [50–65] vs. 72 [62–81], p < 0.0001, and was less likely in suspected large vessel etiology (p = 0.02). Abnormal TTE lead to treatment change in 24 (5%) patients; 22/24 were started on anticoagulation. TTE results were less likely to influence treatment changes in older patients (71 [60–80] vs. 58 [49–69] years, p = 0.02) with known atrial fibrillation (p = 0.01).Conclusion: Our findings suggest that despite widespread use, the overall yield of TTE in AIS is low. Stratifying patients according to their likelihood of benefitting from it will be important toward better resource utilization.
Highlights
Identification of the etiology of acute ischemic stroke (AIS) is crucial for selecting optimal secondary preventative strategies
These recommendations have led to significant uncertainties for practitioners and have implications for cost reimbursements; the guidelines do not specify which patients are likely to benefit from transthoracic echocardiography (TTE) which is was the rationale for this study
We sought to investigate the utility of TTE as part of AIS workup with a retrospective study investigating the frequency of abnormal echocardiography findings and TTEdriven change in management
Summary
Identification of the etiology of acute ischemic stroke (AIS) is crucial for selecting optimal secondary preventative strategies. Transthoracic Echocardiography in Ischemic Stroke on how management changes are made based on TTE results. The recently released in the 2018 AHA/ASA guidelines take a more direct stance and explicitly advise against routine use of echocardiography in patients with AIS [7]. These recommendations have led to significant uncertainties for practitioners and have implications for cost reimbursements; the guidelines do not specify which patients are likely to benefit from TTE which is was the rationale for this study. We sought to investigate the utility of TTE as part of AIS workup with a retrospective study investigating the frequency of abnormal echocardiography findings and TTEdriven change in management
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