[Is necessary to perform a transthoracic echocardiogram in all the patients with cryptogenic stroke during...

Area of Science:

• Cardiology
• Neurology
• Medical Diagnostics

Background:

• 15-30% of ischemic strokes are cardioembolic, necessitating accurate source identification.
• Transthoracic echocardiography is crucial for evaluating embolic sources in stroke patients.
• Current universal echocardiography use in ischemic stroke shows low diagnostic efficiency due to lack of specific recommendations.

Purpose of the Study:

• To assess the diagnostic accuracy of echocardiography in ischemic stroke patients.
• To compare echocardiography's accuracy with universal indication versus selective risk-based criteria.

Main Methods:

• Retrospective analysis of echocardiograms from acute ischemic stroke patients (2009-2011).
• Echocardiograms were evaluated for diagnostic and etiological contributions.
• Selection criteria for high-risk patients included age (<60), ECG abnormalities, cardiomegaly, heart disease history, suspected endocarditis, or active neoplasia.

Main Results:

• 201 out of 930 inpatients (21.6%) underwent echocardiography, detecting cardioembolic sources in 9.95%.
• Applying selection criteria reduced the number of indicated echocardiograms to 97 patients (10.4%).
• The proposed criteria demonstrated high sensitivity (95%) and negative predictive value (99%), with specificity of 56.9%.

Conclusions:

• Implementing risk-based clinical criteria significantly improves the efficiency of identifying cardioembolic sources in stroke patients.
• This approach allows for targeted echocardiography in high-risk individuals.
• It enables postponement of echocardiography to an ambulatory setting for lower-risk patients, optimizing resource allocation.