Early Echocardiography Has a Low Yield in Patients with Transient Ischemic Attack

Current guidelines recommend patients presenting with transient ischemic attack (TIA) undergo echocardiography to evaluate for a cardiac source. However, echocardiography is not available daily at many centers. We assessed the yield from early transthoracic echocardiography (TTE) in consecutive patients with TIA evaluated in an emergency department observation unit (EDOU) protocol.

This observational cohort study took place in an academic medical center from January 1, 2011 to July 31, 2013. Patients seen in the emergency department, assigned to the EDOU for a TIA accelerated diagnostic protocol and discharged with a diagnosis of TIA were included. We retrospectively collected baseline patient characteristics, ABCD2 score, neuroimaging, telemetry, TTE, and 3-month clinical outcomes.

Of 236 subjects (mean age 62 ± 15 years, 68% female, 57% African American, 17% with history of stroke, 27% with history of cardiac disease, mean ABCD2 score 3.8 ± 1.5, mean EDOU length of stay 18.6 ± 6.2 hours), abnormal bedside cardiac examination was identified in 19 (8%) patients, abnormal electrocardiogram (ECG)/telemetry in 41 (17%), and abnormal TTE in 64 (27%), 41 of which suggested a patent foramen ovale. Among 136 (58%) patients with no previous cardiac disease or stroke, a normal bedside cardiac examination, and normal ECG/telemetry, TTE identified no high-risk cardiac causes.

In patients with TIA presenting to an EDOU with no previous cardiac disease or stroke, normal cardiac examination, and normal ECG/telemetry, early TTE had a low yield for identifying high-risk cardiac causes. In EDOUs where TTE is not available daily, outpatient TTE for this patient subgroup may be considered to limit prolonged lengths of stay.