Diagnostic Yield of Echocardiography in Transient Ischemic Attack

Area of Science:

• Cardiology
• Neurology
• Diagnostic Imaging

Background:

• Echocardiography is frequently used to detect cardiac sources of embolism (CSE) in transient ischemic attack (TIA) patients.
• The diagnostic utility and routine use of echocardiography for TIA evaluation remain subjects of debate.
• Uncertainty exists regarding the definitive diagnostic yield of echocardiography in identifying CSEs causing TIA.

Purpose of the Study:

• To prospectively evaluate the diagnostic yield of echocardiography in identifying cardiac sources of embolism (CSE) in patients presenting with acute transient ischemic attack (TIA).
• To determine the frequency of CSE identification and its impact on antithrombotic therapy in a TIA cohort.
• To identify predictors of CSE detection via echocardiography in patients with TIA.

Main Methods:

• Prospective enrollment of patients with acute TIA across four stroke centers.
• Definition of CSE according to the Causative Classification of Stroke system, with specific criteria for patent foramen ovale.
• Exclusion of patients with a known CSE at admission; analysis focused on the yield of echocardiography in the remaining cohort.

Main Results:

• Of 740 TIA patients evaluated, echocardiography identified a potential CSE in 60 (10%).
• Complex aortic arch atherosclerosis and patent foramen ovale were the most frequent CSEs detected.
• Predictors for CSE included history of coronary artery disease and acute infarction on MRI, significantly increasing echocardiography yield (up to 29%). Anticoagulation was initiated in only 2.5% of patients based on findings.

Conclusions:

• Echocardiography reveals relevant cardiac sources of embolism in a substantial proportion of TIA patients.
• Despite identifying potential CSEs, echocardiography infrequently leads to changes in antithrombotic therapy.
• The study highlights the importance of considering patient comorbidities like coronary artery disease and MRI findings when interpreting echocardiography results for TIA.