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Echocardiography in the detection of cardioembolism in a stroke population

Omar Ahmad1, Kate E Ahmad, Keith B G Dear

  • 1Department of Neurology, The Canberra Hospital, P.O. Box 11, Woden, ACT, 2611, Australia.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
|March 9, 2010
PubMed

Insights

Echocardiography, including transthoracic (TTE) and transoesophageal (TOE) scans, has a low diagnostic yield for stroke investigation. Abnormal findings are most common in patients with existing cardiac disease, suggesting a targeted approach is needed.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Imaging

Background:

  • Transthoracic echocardiography (TTE) and transoesophageal echocardiography (TOE) are standard diagnostic tools for investigating ischaemic stroke.
  • The routine use and predictive value of these imaging modalities require further evaluation.

Purpose of the Study:

  • To assess the incidence of abnormalities detected by TTE and TOE in patients with ischaemic stroke.
  • To determine if clinical cardiological examination and ancillary tests can predict abnormal echocardiography results.

Main Methods:

  • Retrospective analysis of data from 428 patients who underwent TTE and/or TOE for ischaemic stroke investigation.
  • Evaluation of the diagnostic yield of TTE and TOE and the impact on patient management.

Main Results:

  • The diagnostic yield for TTE was 12%, while for TOE it was 40% among performed tests.
  • Echocardiography altered management in 5% of patients.
  • A significant correlation was observed between clinical cardiac disease, stroke subtype, and TTE diagnostic yield.

Conclusions:

  • The majority of abnormal echocardiography findings in stroke patients occur in those with pre-existing clinical cardiac disease.
  • Routine echocardiography for all ischaemic stroke patients is not supported; an individualized approach based on clinical suspicion is recommended.

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