Cardiological diagnostic work-up in stroke patients--a comprehensive study of test results and therapeutic...

Area of Science:

• Neurology
• Cardiology
• Diagnostic Imaging

Background:

• Stroke patients in Western countries often undergo routine diagnostic tests.
• The clinical value of tests like ECG, echocardiography, carotid ultrasound, and Holter monitoring in unselected stroke patients is limited.
• Data on the yield and consequences of positive test results in stroke patients are scarce.

Purpose of the Study:

• To evaluate the yield of routine diagnostic tests in stroke patients.
• To assess the impact of positive test results on patient management, particularly drug therapy and anticoagulation.
• To determine the utility of ECG, echocardiography, carotid ultrasound, and Holter monitoring in stroke evaluation.

Main Methods:

• Consecutive stroke patients with imaging-confirmed ischemic lesions were included.
• Stroke etiology was determined using the TOAST classification.
• Rates of positive test results and their influence on therapeutic changes were analyzed.

Main Results:

• Positive findings were observed in 19% of ECGs, 24% of carotid ultrasounds, and 24% of echocardiograms.
• Overall, 41% of patients had at least one positive test result.
• Therapeutic changes occurred in 37% of patients with positive echocardiograms and 51-56% with other positive tests.

Conclusions:

• While ECG, carotid ultrasound, and echocardiography showed relatively low positive rates, they significantly impacted management.
• Holter monitoring demonstrated no impact on management and is not recommended for routine stroke evaluation.
• Further research is needed to optimize patient selection for diagnostic testing in stroke care.