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Should routine echocardiography be performed in all patients with stroke?

Thomas Wolber1, Micha Maeder, Ramin Atefy

  • 1Cardiovascular Center, Cardiology, University Hospital Zurich, Zurich, Switzerland. thomas.wolber@usz.ch <thomas.wolber@usz.ch>

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|August 11, 2007
PubMed

Insights

Echocardiography effectively identifies cardiac sources of embolism in younger stroke patients. Routine screening is less beneficial for older individuals, where selective testing is recommended.

Area of Science:

  • Neurology
  • Cardiology
  • Diagnostic Imaging

Background:

  • Cardiogenic embolism is a significant cause of ischemic stroke, ranging from 15% to 30%.
  • Echocardiography is commonly used to screen for cardiac embolism sources in stroke patients.
  • The routine utility of echocardiography for this purpose is debated.

Purpose of the Study:

  • To evaluate the diagnostic yield of echocardiography in unselected patients with acute ischemic stroke.
  • To determine the effectiveness of echocardiography in identifying cardiac sources of embolism (CSE).

Main Methods:

  • Consecutive patients with ischemic stroke or transient ischemic attack were enrolled.
  • All patients underwent transthoracic echocardiography.
  • Transesophageal echocardiography was used for selected patients.

Main Results:

  • A potential cardiac source of embolism (CSE) was identified in 18% of 775 patients.
  • Atrial fibrillation (7%) and patent foramen ovale (6%) were the most common CSEs.
  • Diagnostic yield was higher in patients under 50, with a 10-fold lower number needed to test compared to patients over 70.

Conclusions:

  • Echocardiography provides valuable information for determining ischemic stroke causes.
  • Routine echocardiographic screening is not universally indicated for all stroke patients.
  • Echocardiography is recommended for routine use in patients under 50 with stroke; selective use is advised for older patients.
Abstract

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